Turkish Journal of Hematology Volume: 37 Issue: 1 / 2020

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59 Children with Iron Deficiency Anemia Have a Tendency to Hypercoagulation: An Evaluation by ThromboelastographyCeren Kılcı, Lale Olcay, Beril Özdemir, Ali Fettah, Meriç Yavuz Çolak; Ankara, Turkey62 Successful Hemostasis with Extended Half-life Recombinant Factor VIII in CircumcisionBaşak Koç, Metin İshak Öztürk, Bülent Zülfikar; İstanbul, Turkey64 Accidental High-dose Intrathecal Treatment: Late Results of a PatientTiraje Celkan, Evrim Çifçi Sunamak; İstanbul, Turkey65 CMV-specific T-Cells for Treatment of CMV Infection after Hematopoietic Stem Cell Transplantation in a Pediatric Case:First Application in TurkeySevil Celilova, Ersin Toret, Başak Aksoy Adaklı, Ercüment Ovalı, Ceyhun Bozkurt; İstanbul, Turkey67 Comparison of Different Culture Conditions for Mesenchymal Stem Cells from Human Umbilical Cord Wharton’s Jelly for Stem Cell TherapyYu Bao, Shumin Huang, Zhengyan Zhao; Zhejiang, China70 Vacuolated Blasts in the Bone Marrow of a Child with RhabdomyosarcomaEda Ataseven, Dilek Ece, Nazan Özsan, Mehmet Kantar; İzmir, Turkey72 T-Cell Lymphoblastic Lymphoma Showing Aberrant Synaptophysin Expression in a ChildNazım Emrah Koçer, Bermal Hasbay, Fazilet Kayaselçuk; Adana, Turkey74 Hydroxyurea-induced Tooth DiscolorationMuhammed Okuyucu, Memiş Hilmi Atay; Samsun, Turkey75 Rare Presentation of Herpes Virus Lesions in a Case of Acute Pre-B Lymphoblastic LeukemiaEylem Kaymaz, Zeliha Güzelküçük, Melek Işık, Neşe Yaralı; Ankara, TurkeyA-X
REVIEWDOI: 10.4274/tjh.galenos.2019.2019.0157Turk J Hematol 2020;37:1-4Acute Graft-Versus-Host Disease: A Brief ReviewAkut Graft Versus Host Hastalığı: Kısa Bir DerlemeElifcan Aladağ 1 , Engin Kelkitli 2 , Hakan Göker 11Hacettepe University Faculty of Medicine, Department of Hematology, Ankara, Turkey2Ondokuz Mayıs University Faculty of Medicine, Department of Hematology, Samsun, TurkeyAbstractGraft‐versus‐host disease (GvHD) is an important complicationthat can be observed after allogeneic hematopoietic stem celltransplantation (allo-HSCT). Acute GvHD (aGvHD) is seen after allo-HSCT and the incidence of aGvHD is around 30%-50%. aGvHDprophylaxis is essential in patients undergoing allo-HSCT. Initialtherapy for aGvHD is steroids. Prognosis is poor in aGvHD patientsnot responding to steroids. In this article, the pathobiology, clinicalfindings, prophylaxis, and treatment of aGvHD will be summarized.Keywords: Graft-versus-host disease, Acute, ChronicÖzAkut graft‐versus‐host hastalığı (GvHD), allojeneik hematopoetikkök hücre nakli (alloHKHN) sonrasında görülebilen önemli birkomplikasyondur. Akut GvHD (aGvHD) insidansı yaklaşık %30-50oranında görülmektedir. AlloHKHN yapılan hastalarda GvHD proflaksisiönemlidir. aGvHD gelişen hastalarda başlangıç tedavisi steroiddir.Steroide yanıtsız aGvHD’de prognoz kötüdür. Bu yazıda aGvHDpatobiyolojisi, klinik bulguları, profilaksisi ve tedavisi özetlenecektir.Anahtar Sözcükler: Graft‐versus‐host hastalığı, Akut, KronikAcute Graft-Versus-Host Disease (GvHD)Acute graft‐versus‐host disease (aGvHD) is seen after allogeneichematopoietic stem cell transplantation (allo-HSCT) [1,2,3,4].The incidence of aGvHD is around 30%-50% in HLA fullymatched allo-HSCT [1]. aGvHD is also common in haploidenticaland matched unrelated donor transplantation [1,2].PathobiologyIn 1966, Billingham detailed the biology of GvHD developmentas a three-stage process: a) the graft/donor should containimmunologically competent cells, b) the recipient/host musthave tissue antigens not expressed in donor cells, and c) therecipient should be unable to mount an immune response toeffectively eliminate the donor cells [3,5]. Hence, during allo-HSCT, after conditioning the host, tissue antigens of the recipientare expressed to the donor T-cells, which leads to donor T-cellactivation, expression, and enhanced immune response to thehost; in other words, aGvHD occurs [1,2,3,4]. The mechanismunderlying tissue damage in aGvHD is massive inflammatorycytokine secretion. Proinflammatory cytokines [tumor necrosisfactor (TNF)-α, interleukin (IL)-1β, and IL-6] are seen, as wellas the increased expression of the receptor repertoire (patternrecognition receptors) on antigen-presenting cells [6].Risk FactorsThe most important risk factor for aGvHD is HLA mismatch.Other risk factors include sex disparity between donor andrecipient, the intensity of the conditioning regimen, increasedage, multiparous female donors, ineffective GvHD prophylaxis,and the source of the graft. A study showed that aGvHDwas significantly more common with total body irradiationinvolving a myeloablative regimen and peripheral stem celltransplantation from a fully matched related donor. In thatstudy, the use of tacrolimus and methotrexate for GvHDprophylaxis was associated with a significant increase in GvHDrisk compared to a cyclosporine-methotrexate combination [1].Clinical ManifestationsGvHD can be acute or chronic based on the clinical presentationand its occurrence after or before 100 days after allo-HSCT. aGvHDmay occur beyond this arbitrary cut-off of 100 days. The widelyaccepted National Institutes of Health consensus criteria have©Copyright 2020 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Hakan Göker M.D., Hacettepe University Faculty of Medicine,Department of Hematology, Ankara, TurkeyPhone : +90 505 822 99 16E-mail : hgoker1@yahoo.com ORCID: orcid.org/0000-0002-1039-7756Received/Geliş tarihi: April 14, 2019Accepted/Kabul tarihi: September 2, 20191
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