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Treatment of acute graft-versus-host disease

Nelson J Chao, MD
Section Editor
Robert S Negrin, MD
Deputy Editor
Alan G Rosmarin, MD


Acute graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic cell transplant (HCT) that classically presents in the early post-transplantation period. It is thought to be primarily a T cell mediated disease that occurs when immune cells transplanted from a non-identical donor (the graft) recognize the transplant recipient (the host) as foreign, thereby initiating an immune reaction that causes disease in the transplant recipient. The skin, gastrointestinal tract, and liver are the principal target organs in patients with acute GVHD.

Clinically significant acute GVHD occurs in 9 to 50 percent of patients who receive an allogeneic HCT from a genotypically HLA-identical sibling, despite intensive prophylaxis with immunosuppressive agents, such as methotrexate, cyclosporine, corticosteroids, mycophenolate mofetil, or antithymocyte globulin. Acute GVHD is more common following HCT from matched unrelated donors and haploidentical donors. (See "Donor selection for hematopoietic cell transplantation".)

The management of acute GVHD will be reviewed here. Specific recommendations for the prevention and diagnosis of GVHD are discussed separately. (See "Prevention of acute graft-versus-host disease" and "Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease".)


Prevention of GVHD — Prophylaxis of acute GVHD centers on immunosuppression of the donor cells, either pharmacologically or via T cell depletion. There is no agreed upon standard regimen, and clinical practice varies by institution. However, each institution must have guidelines for the prevention and management of GVHD in order to be acknowledged by international accrediting organizations. This is discussed in more detail separately. (See "Prevention of acute graft-versus-host disease", section on 'Choice of prophylaxis'.)

Diagnosis of GVHD — Acute GVHD can involve the skin, gastrointestinal tract, and liver. The diagnosis can be made readily on clinical grounds in the patient who presents with a classic rash, abdominal cramps with diarrhea, and a rising serum bilirubin concentration within the first 100 days following hematopoietic cell transplantation (HCT), most often within two to three weeks following HCT. (See "Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease".)

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Literature review current through: Nov 2017. | This topic last updated: Jul 11, 2017.
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