總結

• A major cause of morbidity and mortality following allogeneic haematopoietic cell transplantation (HCT), which continues to limit the broader application of this therapy.
• Occurs when donor T cells respond to host antigens.
• Acute and chronic forms have traditionally been defined based on the timeframe post-transplant (less than or greater than 100 days, respectively). However, current consensus is that clinical manifestations guide whether the signs and symptoms of graft-versus-host disease (GVHD) are acute, chronic, or an overlap syndrome.
• Acute GVHD classically targets the skin, liver, and GI tract. In contrast, chronic GVHD can involve almost any organ.
• Prophylaxis against acute GVHD usually comprises a calcineurin-based inhibitor such as ciclosporin or tacrolimus (which block T-cell activation), administered with other immunosuppressants such as low-dose methotrexate or mycophenolate.
• Optimum treatment of both acute and chronic forms of GVHD is yet to be fully defined, but current practice usually involves the use of systemic corticosteroids with additional immunosuppressants as required, often as part of a clinical trial.
• Supportive care and monitoring are vital components of chronic GVHD management with emphasis on infection prophylaxis, physiotherapy, nutritional status, pain control, and monitoring of drug-drug interactions and drug-related adverse effects.