Chronic graft-versus-host disease after allogeneic stem cell transplantation

Chronic Graft-versus-Host disease (chronic GVHD) is a clinicopathological syndrome which is the major determinant of long-term outcome and quality of life after allogeneic bone marrow or peripheral stem cell transplantation. Chronic GVHD may develop within 3 to 18 months after allografting and occurs in approximately 33% of HLA-identical sibling recipients and 50-70% of recipients of unrelated or mismatched-related marrow grafts. Individuals with the limited chronic GVHD have a favorable course and patients with extensive chronic GVHD have an unfavorable natural history. Chronic GVHD is a pleiotropic disease with clinical and pathological signs and symptoms similar to several naturally occurring autoimmune disorders. Organ involvement in extensive chronic GVHD affects the skin, mouth, eyes, sinuses, gastrointestinal tract, lungs, muscles, tendons, serous surfaces and nerves. Owing to the prolonged time to immunological recovery sinopulmonary infections may be common in patients with chronic GVHD. In standard-risk chronic GVHD patients early treatment with prednisone and cyclosporine has better results in high-risk patients. New treatment approaches include the use of FK506, thalidomide, mycophenolate mofetil, rapamycin and extracorporeal photopheresis. Supportive care includes correction of hypogammaglobulinemia and administration of antibiotics to reduce the risk of infection.

Duke Scholars

Author Keith Michael Sullivan Medicine, Hematologic Malignancies and Cellular Therapy