title: How I treat acute graft-versus-host disease of the gastrointestinal tract and the liver.
abstract: Treatment of acute graft-versus-host disease (GVHD) has evolved from a one-size-fits-all approach to a more nuanced strategy based on predicted outcomes. Lower and time-limited doses of immune suppression for patients predicted to have low-risk GVHD are safe and effective. In more severe GVHD, prolonged exposure to immunosuppressive therapies, failure to achieve tolerance, and inadequate clinical responses are the proximate causes of GVHD-related deaths. This article presents acute GVHD-related scenarios representing, respectively, certainty of diagnosis, multiple causes of symptoms, jaundice, an initial therapy algorithm, secondary therapy, and defining futility of treatment.
authors.affiliation: Gastroenterology/Hepatology Section, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA; and University of Washington School of Medicine, Seattle, WA.
authors.forename: George B
authors.identifier: http://orcid.org/0000-0003-0581-2561
authors.initials: GB
authors.lastname: McDonald
mesh_terms: D000208:Acute Disease; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000276:immunology / Q000473:pathology*; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects / Q000276:immunology / Q000473:pathology*
chemical_list: D007166:Immunosuppressive Agents