Chronic graft-versus-host disease after allogeneic stem cell transplantation: challenges in prevention, science, and supportive care.
Chronic GVHD (cGVHD) remains one of the most significant complications affecting the quality of life of long-term survivors of allogeneic stem cell transplant (SCT). Recent advancements in SCT, including the adoption of reduced-intensity conditioning regimens and improvements in inpatient supportive care, have yielded dramatic reductions in early mortality and led to the expanding use of allogeneic SCT in a broader range of patients, including the elderly. In turn, this development has resulted in a growing number of SCT survivors who remain free of their underlying malignancies but who require care for long-term complications, including cGVHD. cGVHD may have protean manifestations and may pose unique diagnostic and therapeutic challenges. To address inconsistencies in the diagnosis, treatment, and supportive care of cGVHD, experts within the SCT community have worked to develop consensus guidelines; these efforts have yielded more precise definitions and will facilitate more uniform clinical trials. With an increase in SCT survivorship, the management of patients with cGVHD is performed as a partnership between SCT physicians and primary oncologists. This review is designed to help general oncologists understand the current state of cGVHD, including its pathogenesis and treatment. The review places particular emphasis on general principles governing the optimal supportive management of cGVHD and examines recent consensus recommendations regarding its diagnosis and management by organ system.
Joseph
Richard W
RW
Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, USA.
Couriel
Daniel R
DR
Komanduri
Krishna V
KV
D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000145:classification / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous