Facts on File Encyclopedia of Health and Medicine

• chronic fatigue


• dry eyes and MOUTH

The diagnostic path includes blood tests to
measure blood cell types and counts, ANTIBODYlev-
els, and liver enzymes. In particular, CD-4+ and
CD-8+ T-lymphocytes are abundant. Tissue biop-
sies also show evidence of damage due to the
immune attack. Doctors classify graft vs. host dis-
ease into four stages, according to the severity of
symptoms; stage 1 is the mildest and stage 4, the
most severe.

Treatment Options and Outlook
At present the most successful treatment is
IMMUNOSUPPRESSIVE THERAPY. Ideally, prophylactic
immunosuppression prevents graft vs. host dis-
ease. When symptoms occur, immunosuppression
can minimize the consequences and limit damage.
Immunosuppression itself carries significant risk,
however. The risk for infection, especially an
OPPORTUNISTIC INFECTIONthe IMMUNE SYSTEMcould
normally keep at bay, is very high. CORTICOSTEROID
MEDICATIONS, the cornerstone of immunosup-

pressive therapy, cause serious side effects with

long-term, systemic use. As well, some immuno-

suppressive agents are chemotoxic (they work by

killing cells) and have harmful side effects. The

balance between sufficient immune suppression

and adequate immune function is delicate.

Other treatment options include MONOCLONAL

ANTIBODIES(MABS), which bind with the ANTIGEN

receptors on the cell membrane surfaces of the

cells in the organ. However, the body may develop

antibodies against the MAbs. Though the first

treatment is successful, subsequent efforts with

the same MAbs will initiate an immune attack

against the MAbs. A number of clinical trials are

exploring investigational treatments for graft vs.

host disease. A key challenge in treatment is that,

although doctors fully understand what happens

during graft vs. host disease, the mechanisms by

which events occur remain unknown.

Risk Factors and Preventive Measures

Anyone who has bone marrow transplantation is

at risk for graft vs. host disease. Optimal matching

of HUMAN LEUKOCYTE ANTIGENS(HLAS) before trans-

264 The Immune System and Allergies

ACUTE GRAFT VS. HOST DISEASE STAGING

Stage Degree of Severity Symptoms
1 mild SKIN RASHaffecting less than 25 percent of the skin surface, often starting on the
hands and feet
no other symptoms

2 moderate skin rash affecting more than 25 percent of the skin surface
mild gastrointestinal discomfort and DIARRHEA
mild JAUNDICE

3 severe extensive SUNBURN-like rash over most of the body
STOMACHdiscomfort, abdominal cramping, diarrhea
frequent or chronic INFECTION
nutritional deficiencies
moderate jaundice and LIVERdysfunction

4 life threatening skin blisters and peeling skin over most of the body
gastrointestinal PAIN
bloody diarrhea
severe jaundice and significant liver dysfunction or LIVER FAILURE
serious INFECTIONor OPPORTUNISTIC INFECTION
malabsorption of NUTRIENTS