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CLINICIAN'S CORNER
Chronic Graft-vs-Host Disease
Vikas Bhushan, MD;
Robert H. Collins, Jr, MD
JAMA. 2003;290:2599-2603.
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INTRODUCTION
Allogeneic hematopoietic cell transplantation (HCT) is a treatment used increasingly for a variety of malignant and nonmalignant diseases of the bone marrow and immune system.1 Although the procedure cures many patients with otherwise incurable diseases, it is often associated with serious immunological complications, particularly graft-vs-host disease (GVHD).2 A chronic form of GVHD afflicts many allogeneic HCT recipients, resulting in dysfunction of numerous organ systems and an oftentimes profound state of immunodeficiency.3-5 Chronic GVHD is the most frequent cause of poor long-term outcome and quality of life after allogeneic HCT. The syndrome typically develops several months after transplantation, when the patient may no longer be under the direct care of the transplant team. The patient's primary physician plays an important role in diagnosis and treatment of the patient with chronic GVHD.
Pathogenesis
Allogeneic HCT involves ablation of the patient's lymphohematopoietic system by . . . [Full Text of this Article]
Incidence, Risk Factors, and Onset
Clinical Manifestations and Staging
Evaluation
Treatment
Immunosuppressive Medications
Infectious Disease Issues
Other Management Issues
Course and Prognosis
Future Directions
Author Affiliation: Hematopoietic Cell Transplantation Program, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
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