Chronic graft-versus-host disease: Current management paradigm and future perspectives

Oral Dis. 2019 May;25(4):931-948. doi: 10.1111/odi.12936. Epub 2018 Aug 14.

Abstract

Introduction: The field of allogeneic hematopoietic cell transplantation (allo-HCT) began in the 1950s, and despite a seven decade history of remarkable clinical advances, graft-versus-host-disease (GVHD) remains the greatest obstacle in its success due to considerable morbidity and mortality. Graft-versus-host disease is the second leading cause of transplantation-related mortality (TRM) after relapse of primary disease. There are two main types of GVHD-acute and chronic-differing in the pathogenesis, time of onset, and clinical presentation.

Objective: This review provides a comprehensive overview of chronic GVHD pathophysiology and current management paradigms, as well as consideration of promising novel therapies.

Conclusion: Chronic GVHD is a serious disease which may be active for years, or even decades, requiring potentially years of immunosuppressive therapies and placing patients at risk for a number of late complications. While the oral cavity has long been recognized to be a prominent target of GVHD, and in particular, chronic GVHD, it must be recognized and appreciated that it is a complex systemic disease with a wide spectrum of clinical manifestations.

Keywords: GVHD; matched; oral; transplant.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Graft vs Host Disease*
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Recurrence