[Solved] Jiang Et Al

Respond with at least 200 words (each) to a classmatesQuestion: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).

1. What are the similarities between graft versus host disease and graft rejection?
2. What are the pathophysiologic differences between graft versus host disease and graft rejection?
3. How would these differences be manifested clinically?
4. 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?

classmate:

What are the similarities between graft versus host disease and graft rejection?
Both graft versus host disease (GVHD) and graft rejection (GR) are complications that can occur after an organ transplant. Both GVHD and graft rejection involves an immune response where one organ identifies the other as foreign (Flinn & Gennery, 2023; Stringer et al., 2023). Both complications occur after the transplant. The organ viewed as foreign, however, differs. Both conditions result in an inflammatory response at the site of transplantation. The immune cells, such as T cells and macrophages, infiltrate the transplanted tissue and release inflammatory cytokines, causing tissue damage and dysfunction. Both conditions might present with similar clinical features. GVHD and graft rejection can present with fever, rash, organ dysfunction, and general systemic symptoms.
What are the pathophysiologic differences between graft versus host disease and graft rejection?
The initiating process significantly differs. In GVD, the immune repertoire of the graft or organ being transplanted recognizes the host as foreign and mounts an inflammatory attack (Perkey & Maillard, 2018). Graft rejection occurs when the recipient's immune system recognizes the transplanted organ or tissue as foreign and mounts an immune response to eliminate it (Alelign et al., 2018). GVHD can be acute or chronic, depending on the timing and severity of symptoms. Acute GVHD usually occurs within the first 100 days while chronic GVHD can occur any time after transplant, but most often within two years after transplant. Graft rejection can be primary or secondary. Primary graft rejection occurs when the donor’s stem cells fail to engraft within the first 30 days after transplant. Secondary graft rejection occurs when the donor’s stem cells initially engraft but then stop working later.

How would these differences be manifested clinically?
The clinical manifestations of GVHD and graft rejection can also differ. Graft rejection often presents with a characteristic rash. Acute GVHD typically causes maculopapular rash, while chronic GVHD may lead to skin thickening and scleroderma-like changes. The clinical manifestations of GR vary depending on the transplanted organ. In heart transplant rejection, patients may experience chest pain and shortness of breath. GVHD can affect the gastrointestinal tract, leading to symptoms such as nausea, vomiting, and diarrhea. Graft rejection can lead to systemic symptoms like fever, malaise, fatigue, and generalized discomfort.

Studies have shown a protective effect of mild to moderate GVHD in cancer patients who have had bone marrow transplants. Based on your understanding, can you explain these findings?

The most probable explanation is the graft-versus-tumor effect (Jiang et al., 2018). In this phenomenon, the donor's immune cells (the graft) not only attack the recipient's healthy cells (the host) but also any remaining cancer cells. The donor's immune cells are more likely to attack
cancer cells that are similar to the donor's own cells. In some cases, the GVT effect can be so strong that it can actually prevent the cancer from coming back. However, this effect is not guaranteed and may vary depending on the type and stage of cancer, the degree of HLA matching, and the intensity of immunosuppression. A fair balance of these factors is needed.