Graft-Versus-Host Disease — Recognising and Managing a Transplant Complication

Acute GVHD

Acute GVHD typically presents within the first 100 days with rash, diarrhoea, nausea, abdominal pain or jaundice. Staging by organ involvement guides treatment. First-line therapy is usually systemic corticosteroids, with additional agents for steroid-refractory disease. Infection risk rises with immunosuppression, so prophylaxis and surveillance are integral.

• Skin rash, diarrhoea, nausea and jaundice
• Organ staging and biopsy where needed
• Systemic corticosteroids as first-line therapy
• Second-line options for steroid-refractory disease
• Infection prophylaxis during immunosuppression

Chronic GVHD

Chronic GVHD may involve skin, mouth, eyes, liver, lungs, joints and genital tract. It can impair function and quality of life. Diagnosis is clinical with biopsy support where needed. Treatment combines corticosteroids with steroid-sparing agents, plus organ-specific supportive care and rehabilitation.

• Skin, mouth, eye, liver, lung and joint involvement
• Clinical diagnosis with biopsy support
• Corticosteroids and steroid-sparing therapy
• Organ-specific supportive care
• Rehabilitation and quality-of-life focus

Guidelines referenced:

• NIH consensus criteria for chronic GVHD
• ASH guidelines on acute GVHD
• EBMT/ESH handbook on haematopoietic stem cell transplantation