Last reviewed:December 2019
Last updated:December  2018



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
  • 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

Treatment algorithm


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 topic.

Lyndsey Runaas

Instructor, Hematology and Oncology

Division of Hematology/Oncology

Medical College of Wisconsin




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




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.

Use of this content is subject to our disclaimer