Chronic graft-versus-host disease as the most important late complication after allogeneic hematopoietic stem cell transplantation
| Autor: | Brataljenović, Matija |
|---|---|
| Přispěvatelé: | Pulanić, Dražen, Vrhovac, Radovan, Markeljević, Jasenka |
| Jazyk: | chorvatština |
| Rok vydání: | 2018 |
| Předmět: | |
| Popis: | Kronična bolest presatka protiv primatelja (engl. chronic Graft-versus-Host Disease, cGVHD) je multisistemska aloimunosna i autoimunosna bolest koja nastaje nakon alogene transplantacije krvotvornih matičnih stanica (aloTKMS). Učestalost bolesti je 30-70% među pacijentima nakon aloTKMS. Prije 2005. godine svi simptomi prije stotog dana nakon aloTKMS smatrali su se akutnom, a svi simptomi nakon 100 dana od transplantacije kroničnom bolešću. Međutim, prema NIH smjernicama iz 2005., dijagnoza cGVHD-a uspostavlja se isključivo na temelju kliničke slike i dijagnostike, a ne u odnosu na vrijeme nakon aloTKMS. Etiopatogeneza kroničnog GVHD-a temelji se na aloreaktivnom i autoreaktivnom djelovanju T i B limfocita te makrofaga koji uzrokuju fibrozu u zahvaćenim organima. Kronični GVHD zahvaća više organskih sustava, a stupnjevanje osam sustava – koža, oči, usta, gastrointestinalni trakt, jetra, pluća, lokomotorni i genitalni trakt – koristi se u procjeni težine bolesti koja može biti blaga, umjerena i teška. Za blagu bolest najčešće je dovoljna topikalna terapija, dok je za umjerenu i tešku bolest potrebna sistemska imunosupresivna terapija. Kronični GVHD još je uvijek nedovoljno istražena bolest i u tijeku su brojna ispitivanja s ciljem otkrivanja što učinkovitije terapije, biomarkera i preventivnih mjera. Chronic Graft-versus-Host Disease (cGVHD) is a multisystemic alloimmune and autoimmune illness which occurs after allogeneic hematopoietic stem cell transplantation (alloHSCT). The incidence rate is 30-70% among patients after alloHSCT. Prior to 2005, any symptoms occuring before the 100th day after alloHSCT were considered to be signs of acute and any symptoms occurring later to be signs of chronic disease. However, according to the NIH consensus written in 2005, the diagnosis of cGVHD is based entirely on the clinical picture and further diagnostic testing, instead of time after alloHSCT. The etiopathogenesis of cGVHD is based on the alloreactive and autoreactive T and B lymphocytes and macrophages which cause fibrosis in target organs. Chronic GVHD targets many organ system, and scoring 8 of them – skin, eyes, mouth, gastrointestinal tract, liver, lungs, musculoskeletal, and genital – is important for evaluating disease severity, which can be mild, moderate, and severe. Mild disease usually requires topical treatment, whereas moderate and severe illness require systemic immunosuppressive treatment. Chronic GVHD is still insufficiently researched, and there are many ongoing trials with the goal of discovering better treatment, biomarkers and preventive measures. |
| Databáze: | OpenAIRE |
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