Last reviewed:November 2019
Last updated:December  2018

Summary

Definition

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
  • 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
  • absent or suboptimal 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 upper GI endoscopy
  • 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) scan
Full details

Treatment algorithm

Contributors

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 topic.

Lyndsey Runaas

Instructor, Hematology and Oncology

Division of Hematology/Oncology

Medical College of Wisconsin

Milwaukee

WI

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 topic. PR is an author of a number of references cited in this topic.

Peer reviewersVIEW 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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