Posted: April 7th, 2023

An adult patient with a chronic myelogenous leukemia

An adult patient with a chronic myelogenous leukemia sits down with you to discuss his questions and concerns about his upcoming bone marrow transplant. He has already received some educational materials and participated in a family conference during which health team members described the procedure and potential complications. He has been told that he has a risk of graft rejection or graft versus host disease (GVHD), but he does not understand the distinction (Chapter 12, Learning Objectives 1, 2, 10, 11).

What are the similarities between graft versus host disease and graft rejection?
What are the pathophysiologic differences between graft versus host disease and graft rejection?
How would these differences be manifested clinically?
Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had a bone marrow transplant. Based on your understanding, can you explain these findings?
Instructions:

Your primary post should be at least 200 words long and should include reference to the textbook or another course resource using APA 7th edition format. Your primary post is due by Wednesday at midnight ET.
Respond with at least 100 words (each) to at least two classmates’ posts by Sunday at midnight ET.

Graft rejection and graft versus host disease (GVHD) are two different immunological processes that can occur after a bone marrow transplant. Graft rejection occurs when the recipient’s immune system attacks and rejects the transplanted bone marrow, leading to failure of engraftment. GVHD, on the other hand, occurs when the transplanted immune cells recognize the recipient’s tissues as foreign and attack them, leading to tissue damage.

The similarities between graft rejection and GVHD include that both can lead to the failure of the transplant, both are mediated by immune cells, and both can cause significant morbidity and mortality if not managed properly.

The pathophysiologic differences between graft rejection and GVHD are that graft rejection is a cell-mediated immune response directed against the donor bone marrow cells, whereas GVHD is a complex interplay of T-cell activation and cytokine release leading to the attack of the host tissues by the transplanted immune cells.

Clinically, graft rejection is manifested as a failure of engraftment, with a decrease in the number of donor cells and an increase in the recipient’s own cells in the bone marrow. GVHD can present with a variety of symptoms, including skin rash, diarrhea, liver dysfunction, and in severe cases, multiorgan failure.

Studies have shown that mild to moderate GVHD can have a protective effect in cancer patients who have had a bone marrow transplant. This may be due to the graft versus leukemia effect, where the transplanted immune cells attack any remaining cancer cells in the recipient’s body. However, severe GVHD can still lead to significant morbidity and mortality and needs to be managed promptly.

Reference: Yarbro, C. H., Wujcik, D., & Gobel, B. H. (2018). Cancer Nursing: Principles and Practice. Jones & Bartlett Learning.

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