title: Peripheral blood stem cell transplantation and graft-versus-host disease: a case study.
abstract: Peripheral blood stem cell transplantation is an acceptable treatment option for children with hematologic malignancies that are refractory to traditional treatments. Reports in the literature suggest that acute graft-verus-host disease (aGVHD), a common complication of peripheral blood stem cell transplantation, is associated with significant morbidity and mortality. aGVHD, a complex immunologic response, is reported in allogeneic transplants in which there is antigen presentation and activation of the donor T cell. The release of cytokines from the activated lymphocytes results in host cell death. This article reports on a 3-year-old child with a hematologic malignancy who, upon relapse, had received an identically matched allogeneic stem cell transplant from a sibling. Prophylaxis against aGVHD included several immunosuppressive agents. The dosage and serum levels of mycophenolate mofetil and tacrolimus were carefully monitored; however, the aGVHD progressed to include the liver and gut. As the child continued to deteriorate the aggressive treatment against aGVHD continued without success. A review of this case of aGVHD will provide nurses a knowledge base that is necessary to provide optimal care to the patient and family members alike.
authors.affiliation: Columbia University School of Nursing, 617 W. 168th Street, New York, NY 10032.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Cimiotti
mesh_terms: D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000494:pharmacology; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000451:nursing* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000451:nursing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D012008:Recurrence; D014184:Transplantation, Homologous
chemical_list: D016207:Cytokines; D007166:Immunosuppressive Agents