An Overview of Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is a potentially fatal complication and is one of the most common causes of non-relapse mortality after allogeneic hematopoietic stem cell transplantation. Factors that determine the risk of GVHD include the degree of human leukocyte antigen matching, donor type, graft source, gender disparity, conditioning intensity, and the type of GVHD prophylaxis. GVHD comprises two distinct entities categorized as acute or chronic depending upon specific manifestations. Acute GVHD may involve the skin, gastrointestinal tract, and/or liver and manifest as a morbilliform rash, nausea, vomiting, secretory diarrhea, and/or cholestatic liver dysfunction, respectively. Chronic GVHD can affect virtually any organ, with the most common being the eyes, mouth, skin, joint/fascia, gastrointestinal tract, liver, lungs, and genitalia. In this chapter, we review the epidemiology, risk factors, pathophysiology, manifestations, classification, and grading for acute and chronic GVHD. We then elaborate on GVHD prevention strategies and briefly detail the treatment of GVHD. Finally, we highlight how consulting clinicians may apply this information when rendering care of allogeneic HCT recipients who are referred to them.