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Old 12-23-2012
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Question Treatment of GVHD?

A 17-year-old girl with a history of refractory B lymphocyte lymphoma undergoes a bone marrow transplant from a matched unrelated donor. On day 19 post-transplant, an erythematous, maculopapular rash is noted on her trunk and extremities. Within 3 days, she has developed diffuse bullae and severe diarrhea. She requires vigorous hydration and narcotic pain medication. Jaundice is noted, and her serum total bilirubin is found to be 10 mg/dL. Which of the following interventions gives the patient the best chance of survival?

(A) Hepatic transplantation
(B) The patient has little chance of survival; donor T lymphocytes should have been removed from the stem cells prior to infusion
(C) Total body irradiation to remove the graft
(D) Treatment with monoclonal antibodies directed at T lymphocytes
(E) Treatment with thalidomide
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Old 12-23-2012
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D, they treat it with immunosuppression.
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Old 12-23-2012
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(D) Treatment with monoclonal antibodies directed at T lymphocytes
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D..............
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Matched!!!
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Old 12-24-2012
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its D......
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(D) Treatment with monoclonal antibodies directed at T lymphocytes
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Old 12-25-2012
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All of you know this concept except me (got it wrong)
The correct answer is D. The patient is experiencing severe acute graft versus-host disease (GVHD), caused by allogeneic T lymphocytes that were transferred with the donorís stem cells reacting with antigenic targets on her own cells. Acute GVHD is usually experienced within 4 weeks of the initial transplant. It is characterized by rash, diarrhea, and decreased liver function, and is graded from I through IV. Significant GVHD develops in up to 60% of patients receiving stem cells from unrelated donors, and 30% of those receiving transplants from siblings. It is usually treated with glucocorticoids, antithymocyte globulin, or monoclonal antibodies targeted against T lymphocytes.
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