Last reviewed: October 2017
Last updated: ??display.month.09_en_GB??  2016



History and exam

Key diagnostic factors

  • allogeneic haematopoietic cell transplantation (HCT) recipient
  • unrelated donor
  • multiparous female donor
  • diffuse maculopapular rash with fever
  • nausea, abdominal pain, and profuse diarrhoea

Other diagnostic factors

  • day +14 after HCT
  • cyclophosphamide + total body irradiation (Cy/TBI) conditioning regimen
  • peripheral blood stem cells as donor source
  • suboptimal GVHD prophylaxis
  • new-onset painful mouth sores
  • hyperpigmented skin lesions
  • dry, gritty, and painful eyes
  • dry, irritated vagina and vulva
  • jaundice
  • hepatomegaly
  • scleroderma

Risk factors

  • HLA disparity
  • recipient or donor in older age group
  • female donor with male recipient
  • multiparous female donor
  • advanced malignant condition
  • high-intensity conditioning radiation regimen
  • peripheral blood stem cells as source of transplant
  • lack of GVHD prophylaxis
  • non-Asian or non-Hispanic ethnicity
  • cytomegalovirus (CMV) seropositive
  • splenectomy
  • low performance status score
  • low socioeconomic status

Diagnostic investigations

1st investigations to order

  • FBC
  • serum electrolytes
  • liver functions tests
  • urinalysis
  • urine culture
  • blood culture
  • stool culture
  • viral polymerase chain reaction (PCR)
Full details

Investigations to consider

  • CT abdomen
  • Doppler ultrasound of the liver
  • tissue biopsy (skin, liver, GI tract, oral lesions, or lung)
  • pulmonary function tests
  • high-resolution CT chest
  • bronchoalveolar lavage (BAL) and culture
  • echocardiogram
  • barium swallow or endoscopy
  • FDG-PET scan
Full details

Treatment algorithm


Authors VIEW ALL

Sung Choi

Assistant Professor

Department of Pediatrics and Communicable Diseases

Division of Pediatric Hematology Oncology/Blood and Marrow Transplantation

University of Michigan

Ann Arbor



SC is an author of a number of references cited in this monograph.

Lyndsey Runaas

Fellow, Hematology and Oncology

Division of Hematology/Oncology

University of Michigan

Ann Arbor



LR declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Harvard Medical School

Dana-Farber Cancer Institute




CC declares that he has no competing interests.

Senior Lecturer

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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