Lymphoma & related disorders

Posttransplant lymphoproliferative disorders (PTLD)

Graft versus host disease

Last author update: 1 September 2011
Last staff update: 23 August 2022

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PubMed Search: Posttransplantation lymphoproliferative disorders graft versus host disease

Nat Pernick, M.D.
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Cite this page: Pernick N. Graft versus host disease. website. Accessed June 1st, 2023.
Definition / general
  • Common complication of allogeneic bone marrow transplantation seen in 20 - 50% of HLA identical and 70% of nonidentical / unrelated recipients
  • Causes 1/3 of bone marrow transplant deaths

  • Acute GVHD: within 100 days of transplant; affects skin, GI tract, liver
  • Skin - maculopapular rash of palms, soles, trunk, later entire body; may progress to bullous patches and desquamation
  • GI - diarrhea (profuse, bloody), nausea, abdominal pain
  • Liver - elevated liver function tests, nausea, vomiting
  • Also oral GVHD with xerostomia

  • Chronic GVHD: after 200 days of transplant; autoimmune-like symptoms, wasting, recurrent infections, prolonged immunodeficiency
  • Due to donor T cytotoxic (CD8+) T cells introduced with bone marrow cells as bystanders that attack recipient tissue
  • Donor T cells recognize host HLA antigens, proliferate and secrete Interleukin-2 and then other cytokines including tumor necrosis factor, IL-1 and interferon, causing tissue damage
  • Increased immunosuppression, irradiation (treatment opposite that of posttransplant lymphoproliferative disease)
Microscopic (histologic) description
    Skin: Transplant Proc 1974;6:367
  • Grade 1: vacuolar degeneration of basal epithelial cells or acanthocytes
  • Grade 2: also dyskeratosis, apoptosis of keratinocytes (eosinophilic bodies) surrounded by lymphocytes, spongiosis, edema of overlying epithelium
  • Grade 3: also splitting and degeneration of acanthocytes and basal cells, causing cleft formation and separation of dermoepidermal junction
  • Grade 4: sloughing of overlying epithelium

  • Early: flatting / atrophy of mucosa, degeneration and loss of crypts; occasional apoptotic bodies surrounded by lymphocytes
  • Late: mucosal sloughing

    Salivary glands:
  • Grade 1: abnormal mononuclear infiltrates with or without ductal epithelial necrosis
  • Grade 2: also obliteration of ducts
Differential diagnosis
  • Chemotherapy effect, drug reaction, infection
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