Graft versus host disease

Graft versus host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (HCT).

Occurs when donor T cells respond to histoincompatible antigens on the host tissues.

Clinical manifestations determine whether the signs and symptoms of GVHD are acute, chronic, or constitute an overlap syndrome.

Acute GVHD classically targets the skin, gastrointestinal tract, and liver. In contrast, chronic GVHD can involve almost any organ.

Standard GVHD prophylaxis comprises a calcineurin inhibitor combined with low-dose methotrexate or mycophenolate. Additional prophylactic agents may be considered in certain patients.

Treatment involves the use of systemic corticosteroids with additional immunosuppressants as clinically indicated.

Supportive care and monitoring are vital components of GVHD management with emphasis on infection prophylaxis, physical therapy, nutritional status, pain control, and monitoring of drug-drug interactions and drug-related adverse effects.

GVHD is a serious and potentially life-threatening complication following allogeneic HCT. GVHD occurs when donor T cells respond to histoincompatible antigens on host tissues.

Clinical manifestations determine whether GVHD is acute or chronic.

Acute GVHD classically involves the skin, gastrointestinal tract, and liver and usually develops within 100 days post-HCT. However, acute GVHD may also develop or persist beyond 100 days post-HCT in some cases (i.e., late acute GVHD).

The clinical manifestations of chronic GVHD are variable, involving almost any organ, and may resemble those seen in autoimmune diseases. Chronic GVHD usually develops after 100 days post-HCT. It may emerge from acute GVHD (progressive type), following a period of resolution from acute GVHD (quiescent or interrupted type), or occur de novo.

Some patients may present with clinical manifestations of both acute and chronic GVHD (i.e., overlap syndrome).