Chronic GVHD

Chronic graft-versus-host disease (GVHD), an immune response of the donor-derived T cells against recipient tissues, occurs in approximately 30-70% of patients receiving an allogeneic transplant. This is a serious, potentially life-threatening post-transplant complication. Early detection of chronic GVHD can help prevent irreversible organ damage and increase the quality-of-life of transplant recipients.

With early detection and advances in understanding the underlying mechanisms of the disease, it may be possible to reduce the morbidity and mortality of this major complication of allogeneic transplantation.

Optimal treatment of chronic GVHD requires a multidisciplinary team approach in making the diagnosis, prompt implementation of systemic and topical treatment, periodic monitoring of the response during the course of disease, calibration of treatment intensity and the use of supportive care to prevent complications and disability. [1]

Screening for Chronic GVHD

Identify clinical manifestations that are potential early indicators of chronic GVHD. If GVHD is suspected, timely collaboration with the patient's transplant center is recommended to confirm the diagnosis and develop and evaluate a treatment plan.

Access Guidelines by Organ/Site:

• Skin*
• Nails*
• Scalp/body hair*
• Eyes*
• Mouth*
• Lungs
• Muscles, fascia, joints*
• GI tract
• Liver
• Genitalia
• Hematopoietic/Immune
• Other manifestations

(Pages marked with asterisks have photos of clinical manifestations of chronic GVHD.)

These guidelines are based on published diagnostic criteria from the National Institutes of Health (NIH) Consensus Development Project on chronic GVHD [2,3,4] and are included in our HCT Guidelines.

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References

1. Flowers MED, Martin P. How we treat chronic graft-versus-host disease. Blood. 2015; 125(4): 606-615. Access
2. Jagasia MH, Greinix HT, Arora M, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(3): 389-401. Access
3. Lee SJ, Wolff D, Kitko C, et al. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: IV. The 2014 Response Criteria Working Group Report. Biol Blood Marrow Transplant. 2015; 21(6): 984-999. Access
4. These guidelines have been developed by the National Marrow Donor Program^® (NMDP)/Be The Match^® in consultation with Sandra A. Mitchell, CRNP, MScN, AOCN; National Institutes of Health Clinical Center; and Steven Z. Pavletic, M.D.; National Cancer Institute, National Institutes of Health, Bethesda, Md. The information in this document does not represent the official position of the NIH or the U.S. Government.