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Graft-versus-host disease (GVHD) and graft-versus-leukaemia

aka GVHD, GvHD, graft-versus-host, graft-versus-host disease, acute GVHD, chronic GVHD, cGVHD, aGVHD, steroid-refractory GVHD, graft-versus-leukaemia, graft-versus-leukemia, GVL, graft-versus-tumour, GVHD prophylaxis

After a donor transplant, the donor's immune cells may attack the patient's skin, gut and liver (graft-versus-host disease) while also hunting down leftover leukaemia (graft-versus-leukaemia). The two effects are linked, so doctors try to keep enough of the second without too much of the first.

Acute GVHD (first 100 days: rash, diarrhoea, jaundice) affects 30-50% of recipients; chronic GVHD (skin, mouth, eyes, lungs, joints) can last years and is the main cause of late morbidity. Prophylaxis uses calcineurin inhibitors, methotrexate, post-transplant cyclophosphamide or abatacept; treatment is steroids, then ruxolitinib (REACH2/3), belumosudil, axatilimab or ibrutinib for refractory disease. Donor lymphocyte infusions deliberately provoke graft-versus-leukaemia at relapse. Allogeneic CAR-T and NK products use gene editing or donor selection to avoid GVHD, and CRS is a different, cytokine-driven phenomenon.

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Treatment jargon

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Cell Therapy

drugs

3
Not mapped hereOral ROCK2 inhibitor
Belumosudil · Rezurock
ApprovedSmall-molecule covalent BTK inhibitor (first generation)
Ibrutinib · Imbruvica
Not mapped hereSmall-molecule JAK1/JAK2 inhibitor
Ruxolitinib · Jakafi / Jakavi

terms

4
Allogeneic stem cell transplant (allo-SCT)Conditioning regimen (myeloablative, reduced-intensity)Cytokine release syndrome (CRS)Immune-related adverse events (irAEs)