Pediatric Cutaneous Graft Versus Host Disease: A Review

医学 体外光采 移植物抗宿主病 造血干细胞移植 光球 免疫学 他克莫司 皮肤病科 疾病 移植 外科 病理
作者
Connie R. Shi,Jennifer T. Huang,Vinod E. Nambudiri
出处
期刊:Current Pediatric Reviews [Bentham Science Publishers]
卷期号:13 (2) 被引量:9
标识
DOI:10.2174/1573396313666170615091733
摘要

Background: Graft versus host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation in the pediatric population. The most common clinical manifestation of GVHD is in the skin. This article will present a review of key concepts related to pediatric cutaneous GVHD, including pathophysiology, clinical epidemiology, diagnosis, and treatment options. Objective: GVHD is an immune-mediated process characterized by an inflammatory immune response in acute GVHD and mixed inflammatory and fibrotic states in chronic GVHD. The clinical presentations of cutaneous GVHD are heterogeneous. Method: Acute cutaneous GVHD classically presents as an erythematous morbilliform eruption appearing within a few weeks after transplantation. Chronic cutaneous GVHD may manifest as poikiloderma, lichenoid lesions, or sclerodermatous changes. The sclerodermatous form of cutaneous GVHD is associated with substantial long-term morbidity, including joint contractures, myalgias, and mobility restriction. Results: First-line pharmacologic treatment options typically include corticosteroids and in some cases, calcineurin inhibitors. Biologics and immunotherapies are an active area of investigation for GVHD that is refractory to corticosteroid treatment. Non-pharmacologic treatment options that have shown benefit for cutaneous GVHD include extracorporeal photopheresis and phototherapy. Conclusion: Accurate diagnosis and treatment of cutaneous GVHD is essential to preventing and alleviating the long-term sequelae and morbidity associated with this condition. Keywords: Graft versus host disease, cutaneous, dermatology, pediatric hematopoietic stem cell transplant, GVHD, HSCT.
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