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.
Graft-versus-host disease (GVHD) is a major complication following allogeneic haematopoietic cell transplantation (HCT) and occurs when donor T cells respond to histoincompatible antigens on the host tissues.
Acute GVHD classically develops within the first 100 days of transplant or can occur beyond 100 days post-transplant with persistent, recurrent, or late-onset symptoms. The principle target organs include the skin, liver, and GI tract.
Chronic GVHD may emerge from acute disease (progressive type), develop following a period of resolution from acute disease (quiescent or interrupted type), or occur de novo. The manifestations can be variable, and are often similar to those seen in autoimmune diseases.
Overlap syndrome is characterised by clinical features that resemble a combination of both acute and chronic GVHD.
Department of Pediatrics and Communicable Diseases
Division of Pediatric Hematology Oncology/Blood and Marrow Transplantation
University of Michigan
SC is an author of a number of references cited in this monograph.
Fellow, Hematology and Oncology
Division of Hematology/Oncology
University of Michigan
LR declares that she has no competing interests.
Associate Professor of Medicine
Harvard Medical School
Dana-Farber Cancer Institute
CC declares that he has no competing interests.
Institute of Child Health
Consultant in Paediatric Immunology & Bone Marrow Transplantation
Great Ormond Street Hospital
WQ declares that he has no competing interests.
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