Peripheral blood stem cell transplantation and graft-versus-host disease: a case study.

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.