Graft-versus-Host Disease Diagnosis

GVHD is a systemic disease caused by donor immune cells attacking recipient tissues, mainly occurring after allogeneic hematopoietic stem cell transplantation. Based on the onset time, it can be divided into acute (<100 days) and chronic (>100 days) types. Clinical manifestations involve multiple organ systems such as skin, liver, and digestive tract. GVHD is a key factor affecting transplant patients’ survival quality and long-term prognosis.

If not diagnosed and intervened early, GVHD can lead to irreversible organ dysfunction. The mortality rate of acute GVHD is as high as 15-40%, while the 5-year survival rate of chronic GVHD patients is only about 50%. Disease progression can result in fatal complications such as liver failure, severe malnutrition, and septic shock, significantly increasing treatment difficulty and medical costs.

Diagnostic Basis of GVHD

1. Characteristic skin manifestations

Acute GVHD typically presents as pruritic maculopapular rashes, initially appearing on the palms, soles, and behind the ears, and gradually spreading to the trunk. Chronic GVHD may manifest as skin sclerosis, pigmentation, or depigmentation. Tissue biopsy can reveal basal cell vacuolar degeneration and keratinocyte apoptosis as characteristic changes.

2. Persistent gastrointestinal symptoms

Patients present with refractory watery diarrhea (>500 ml/day), accompanied by abdominal pain, nausea, and vomiting. Endoscopy may reveal mucosal congestion and erosion, with severe cases showing mucosal detachment. Stool tests can detect significantly elevated levels of α-1 antitrypsin and calprotectin.

3. Abnormal liver function indicators

Mainly manifested as elevated bilirubin and alkaline phosphatase, with mildly increased transaminases. Liver biopsy may show small bile duct degeneration and portal inflammation. Other causes such as viral hepatitis and drug-induced liver injury must be excluded.

4. Ocular involvement

Chronic GVHD typically manifests as dry eye syndrome and conjunctival hyperemia, with severe cases developing corneal ulcers. Schirmer’s test is positive (<5mm/5min), and ocular surface staining reveals characteristic punctate staining.

5. Pulmonary function impairment

Patients may develop progressive dyspnea, with pulmonary function tests showing restrictive ventilation disorder. High-resolution CT can reveal bronchiectasis and ground-glass opacities, which must be distinguished from infectious pneumonia.

6. Hematological biomarkers

Increased levels of inflammatory cytokines such as IL-6, TNF-α, and ST2, as well as REG3α protein levels, are positively correlated with the severity of intestinal GVHD. These biomarkers are useful for early warning and therapeutic evaluation.

7. Oral mucosal lesions

Typical manifestations include oral ulcers, mucosal leukoplakia, and xerostomia. Severe cases may present with restricted mouth opening. Biopsy shows lymphocytic infiltration and epithelial apoptosis.

8. Histopathological examination

Biopsies of skin, liver, or intestine revealing lymphocytic infiltration and epithelial apoptosis are the gold standard for definitive diagnosis. Attention must be paid to biopsy timing and technique to improve diagnostic accuracy.

Conclusion

GVHD is one of the most severe complications after hematopoietic stem cell transplantation, potentially causing multi-organ failure and death. Early diagnosis is critical to improving prognosis and requires comprehensive judgment based on clinical manifestations, laboratory tests, and pathology results. Experts at United Life International Medical Center emphasize that establishing standardized GVHD monitoring systems and implementing risk stratification management can significantly improve diagnostic accuracy and therapeutic effectiveness, providing patients with the best chance for timely treatment.