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Graft Versus Host Disease (GHVD) in Critically Ill Oncologic Patients

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Onco-critical Care

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Abstract

Graft-versus-host-disease (GVHD) is the one of the most common life-threatening complication of allogeneic hematopoietic stem cell transplantation (Allo SCT). Most common causes for ICU admission include respiratory failure, hemodynamic instability, acute kidney injury, infections, bleeding and GVHD. More than 15% of Allo SCT patients admitted to the intensive care unit (ICU) have GVHD, which has been reported to be associated with worsened ICU outcomes. Severe acute GVHD can manifest in form generalized skin involvement, severe diarrhea with ileus or marked hepatic derangement, while bronchiolitis obliterans can present at later stages. Various GVHD prophylaxis like calcineurin inhibitors along with methotrexate, mycophenolate mofetil, or sirolimus have been shown to improve survival in Allo SCT patients. Corticosteroids remain the standard first-line treatment of GVHD, and various second line therapies can be used for steroid-refractory GVHD. GVHD therapy can lead to immune suppression rendering patients susceptible to bacterial, viral, and fungal infections. In this chapter, we will focus on the impact of GVHD and its treatment on the management of the critical care patient.

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Authors and Affiliations

  1. Department of Haematology, AIIMS, New Delhi, New Delhi, India

    Neha Ganju, Sahitya Sri Krishna & Mukul Aggarwal

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  1. Neha Ganju
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  2. Sahitya Sri Krishna
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  3. Mukul Aggarwal
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Editors and Affiliations

  1. Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    Vinod Kumar

  2. Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India

    Nishkarsh Gupta

  3. Department of Onco-Anesthesia and Palliative Medicine, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India

    Seema Mishra

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Ganju, N., Krishna, S.S., Aggarwal, M. (2022). Graft Versus Host Disease (GHVD) in Critically Ill Oncologic Patients. In: Kumar, V., Gupta, N., Mishra, S. (eds) Onco-critical Care. Springer, Singapore. https://doi.org/10.1007/978-981-16-9929-0_22

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  • DOI: https://doi.org/10.1007/978-981-16-9929-0_22

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