Acute graft versus host disease

Graft versus host disease (GVHD) continues to be a major lethal complication of allogeneic hematopoietic stem cell transplantation (HSCT) and the standard of care, high dose steroids, has not changed in 40 years. Approximately 50% of patients with GVHD will develop steroid refractory disease, typically involving the gastrointestinal tract, which has a very poor prognosis. Improvements in our understanding of the pathobiology of GVHD have identified new therapeutic targets. GVHD most commonly affects the skin, but also the gastrointestinal tract and, less commonly, the liver. Prompt clinical suspicion and grading of clinical manifestations are crucial for the appropriate management of the disease and control of its complications. All patients being treated for GVHD need to receive intensive prophylaxis against infectious complications.