Last reviewed: November 2017
Last updated: April  2017

Summary

Definition

History and exam

Key diagnostic factors

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

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

  • CBC
  • 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

Contributors

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

MI

Disclosures

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

MI

Disclosures

LR declares that she has no competing interests.

Dr Sung Choi and Dr Lyndsey Runaas would like to gratefully acknowledge Dr Pavan Reddy, a previous contributor to this monograph. PR is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Harvard Medical School

Dana-Farber Cancer Institute

Boston

MA

Disclosures

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

London

UK

Disclosures

WQ declares that he has no competing interests.

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