Klin Onkol 1997; 10(6): 180-183.
Acute GvHD is the principal complication of allogeneic haematopoietic stem cell transplantation, which remains the major cause of morbidity and mortality.
Despite the fact that patients and donors are matched for antigens of major histocompatibility complex, graft versus host disease continues to be the major clinical problem.
That is the reason why we have established a clinically useful test that is able to predict the occurrence and the grade of severity of acute graft versus host disease (GvHD grade 1-4).
An in vitro skin explant model is based on mixed lymphocyte culture (MLC). Donor lymphocytes are being sensitised against irradiated recipient lymphocytes and subsequently cocultured with recipient´s skin biopsy sections. Histopathological changes are evaluated according to standard criteria of Lerner classification for acute GvHD. We have tested 12 donor - recipient pairs (6 HLA identical siblings, 2 HLA non-identical relatives, 4 unrelated pairs). Only 2 of 12 children had negative skin explant prediction (GvHD≤1). Five of six children who were transplanted with HLA identical haematopoetic stem cells had positive skin explant prediction (GvHD≥2). We have had no false negative result till now. The test was established for the following purposes: A. to select the optimal donor if there are several at disposal, B. to plan optimal GvHD prophylaxis, C. to start-treatment of acute GvHD in time.
