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Graft-versus-Host-Disease (GvHD) – ein Update

Teil 1: Pathophysiologie, Klinik und Stadieneinteilung der GvHD

Graft-versus-Host Disease (GvHD) – an update

Part 1: Pathophysiology, clinical features and classification of GvHD

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Zusammenfassung

Trotz neuartiger Transplantationstechniken im Bereich der allogenen Stammzelltransplantation (SCT) wie optimierte Konditionierungsregime ist die Graft-versus-Host-Disease (GvHD) mit einer signifikanten Morbidität und Mortalität assoziiert. Während die Inzidenz der akuten GvHD in den letzten Jahren weitgehend unverändert blieb, nahm die Inzidenz der chronischen GvHD in den letzten 10 Jahren zu. Die traditionelle Einteilung der GvHD nach dem Zeitpunkt der klinischen Manifestation gilt heute als überholt. Akute GvHD-Bilder treten auch nach 100 Tagen auf, umgekehrt werden primär chronische Bilder auch schon ab dem 2. Monat nach SCT beobachtet. Die aktuell gültige Klassifikation des National Institutes of Health umfasst die klassische akute GvHD bis Tag 100, eine „late-onset“ akute GvHD (nach 100 Tagen) sowie ein Overlap-Syndrom mit Charakteristika einer akuten und chronischen GvHD sowie die klassische chronische GvHD ohne Zeitlimit. Nach wie vor bereitet die Diagnose einer GvHD der Haut häufig differenzialdiagnostische Schwierigkeiten, da Arzneimittelreaktionen und Virusexantheme klinische und histologische Ähnlichkeiten aufweisen können. Im folgenden Weiterbildungsbeitrag sollen in einem ersten Teil zunächst die pathophysiologischen Mechanismen, die Stadieneinteilung, die unterschiedlichen Hautmanifestationen der akuten und chronischen GvHD sowie das histopathologische Bild besprochen werden. In einem zweiten Teil werden die Prognose sowie die Prophylaxe und Therapie der GvHD anhand der aktuellen Literatur diskutiert.

Abstract

GvHD remains associated with significant morbidity and mortality despite new techniques for allogeneic stem cell transplantation (SCT), such as optimized conditioning regimens. Within the past ten years, the incidence of acute GvHD has remained unchanged and the incidence of chronic GvHD has even increased. The traditional classification of GvHD according to the time of clinical manifestation is now out-dated. Acute GvHD symptoms may even occur after 100 days; vice versa, primary chronic GvHD may already be observed one month after stem cell transplantation. The current classification introduced by the National Institutes of Health includes classic acute GvHD (up to 100 days), late-onset acute GvHD (after 100 days), as well as an overlap syndrome showing features of acute and chronic GvHD and classic chronic GvHD without any time limit. Diagnosis of GvHD of the skin remains difficult because of histological similarities to drug eruptions and viral exanthems. In this first part of the article the pathophysiology, classification, skin manifestations of acute and chronic GvHD and the histopathology will be presented. In a second part the prognosis, prophylaxis and therapy of GvHD will be discussed.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Deutschland

    R. Travnik, M. Beckers, M. Landthaler &  S. Karrer

  2. Klinik und Poliklinik für Innere Medizin I, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    D. Wolff & E. Holler

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  1. R. Travnik
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  2. M. Beckers
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  3. D. Wolff
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  4. E. Holler
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  5. M. Landthaler
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  6. S. Karrer
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Correspondence to S. Karrer.

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Travnik, R., Beckers, M., Wolff, D. et al. Graft-versus-Host-Disease (GvHD) – ein Update. Hautarzt 62, 139–155 (2011). https://doi.org/10.1007/s00105-010-2107-4

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