Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Mini Review
  • Published:

Mini-Review

Chronic graft-versus-host disease: clinical manifestation and therapy

Bone Marrow Transplantation volume 28, pages 121–129 (2001)Cite this article

Abstract

Chronic graft-versus-host disease (GVHD) is a major cause of morbidity and mortality in long-term survivors of allogeneic stem cell transplantation. The immunopathogenesis of chronic GVHD is, in part, TH-2 mediated, resulting in a syndrome of immunodeficiency and an autoimmune disorder. The most important risk factor for chronic GVHD is prior history of acute GVHD and strategies that prevent acute GVHD also decrease the risk of chronic GVHD. Other important risk factors are the use of a non-T cell-depleted graft, and older age of donor and recipient. Whether recipients of peripheral blood stem cells are at increased risk of chronic GVHD remains unsettled. There are no known pharmacologic agents which can specifically prevent development of chronic GVHD. Agents which have efficacy in the treatment of autoimmune disorders have been utilized as therapy for established chronic GVHD and are associated with response rates of 20% to 80%. Most responses are confined to skin, soft tissue, oral mucosa and occasionally liver. Bronchiolitis obliterans responds infrequently to therapy and is associated with a dismal prognosis. Newer, promising therapeutic strategies under investigation include thalidomide, photopheresis therapy, anti-tumor necrosis factor and B cell depletion with anti-CD20 monoclonal antibody. Bone Marrow Transplantation (2001) 28, 121–129.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ratanatharathorn V, Nash RA, Przepiorka D et al. Phase III study comparing methotrexate and tacrolimus (prograf, FK506) with methotrexate and cyclosporine for graft-versus-host disease prophylaxis after HLA-identical sibling bone marrow transplantation Blood 1998 92: 2303–2314

    CAS  PubMed  Google Scholar 

  2. Nash RA, Antin JH, Karanes C et al. Phase 3 study comparing methotrexate and tacrolimus with methotrexate and cyclosporine for prophylaxis of acute graft-versus-host disease after marrow transplantation from unrelated donors Blood 2000 96: 2062–2068

    CAS  PubMed  Google Scholar 

  3. Wingard JR, Piantadosi S, Vogelsang GB et al. Predictors of death from chronic graft-versus-host disease after bone marrow transplantation Blood 1989 74: 1428–1435

    CAS  PubMed  Google Scholar 

  4. Socie G, Stone JV, Wingard JR et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry New Engl J Med 1999 341: 14–21

    Article  CAS  PubMed  Google Scholar 

  5. Kernan NA, Bartsch G, Ash RC et al. Analysis of 462 transplantations from unrelated donors facilitated by the National Marrow Donor Program New Engl J Med 1993 328: 593–602

    Article  CAS  PubMed  Google Scholar 

  6. McGlave P, Bartsch G, Anasetti C et al. Unrelated donor marrow transplantation therapy for chronic myelogenous leukemia: initial experience of the National Marrow Donor Program Blood 1993 81: 543–550

    CAS  PubMed  Google Scholar 

  7. Shulman HM, Sullivan KM, Weiden PL et al. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients Am J Med 1980 69: 204–217

    Article  CAS  PubMed  Google Scholar 

  8. Snover DC . Acute and chronic graft versus host disease: histopathological evidence for two distinct pathogenetic mechanisms Hum Pathol 1984 15: 202–205

    CAS  PubMed  Google Scholar 

  9. Hakim F, Mackall CL . The immune system: effector and target of graft-versus-host disease In: Ferrara JL, Deeg HJ, Burakoff SJ (eds) Graft-vs-Host Disease Marcel Dekker: New York 1997 pp 257–289

    Google Scholar 

  10. Claman HN . Graft-versus-host disease and animal models for scleroderma Curr Opin in Rheumatol 1990 2: 929–931

    CAS  Google Scholar 

  11. Levi-Schaffer F, Mekori YA, Segal V et al. Histamine release from mouse and rat mast cells cultured with supernatants from chronic murine graft-vs-host splenocytes Cell Immunol 1990 127: 146–158

    CAS  PubMed  Google Scholar 

  12. Graze PR, Gale RP . Chronic graft versus host disease: a syndrome of disordered immunity Am J Med 1979 66: 611–620

    CAS  PubMed  Google Scholar 

  13. Sherer Y, Shoenfeld Y . Autoimmune diseases and autoimmunity post-bone marrow transplantation Bone Marrow Transplant 1998 22: 873–881

    CAS  PubMed  Google Scholar 

  14. Quaranta S, Shulman H, Ahmed A et al. Autoantibodies in human chronic graft-versus-host disease after hematopoietic cell transplantation Clin Immunol 1999 91: 106–116

    CAS  PubMed  Google Scholar 

  15. Rouquette-Gally AM, Boyeldieu D, Prost AC et al. Autoimmunity after allogeneic bone marrow transplantation. A study of 53 long-term-surviving patients Transplantation 1988 46: 238–240

    CAS  PubMed  Google Scholar 

  16. Lister J, Messner H, Keystone E et al. Autoantibody analysis of patients with graft versus host disease J Clin Lab Immunol 1987 24: 19–23

    CAS  PubMed  Google Scholar 

  17. Siegert W, Stemerowicz R, Hopf U . Antimitochondrial antibodies in patients with chronic graft-versus-host disease Bone Marrow Transplant 1992 10: 221–227

    CAS  PubMed  Google Scholar 

  18. Seidler CW, Mills LE, Flowers ME et al. Spontaneous factor VIII inhibitor occurring in association with chronic graft-versus-host disease Am J Hematol 1994 45: 240–243

    CAS  PubMed  Google Scholar 

  19. Abrahams VM, Cambridge G, Lydyard PM et al. Induction of tumor necrosis factor alpha production by adhered human monocytes: a key role for Fcgamma receptor type IIIa in rheumatoid arthritis Arth Rheum 2000 43: 608–616

    CAS  Google Scholar 

  20. Edwards JC, Cambridge G, Abrahams VM . Do self-perpetuating B lymphocytes drive human autoimmune disease? Immunol 1999 97: 188–196

    CAS  Google Scholar 

  21. Bhatia A, Blades S, Cambridge G et al. Differential distribution of Fc gamma RIIIa in normal human tissues and co-localization with DAF and fibrillin-1: implications for immunological microenvironments Immunol 1998 94: 56–63

    CAS  Google Scholar 

  22. Edwards JC, Cambridge G . Rheumatoid arthritis: the predictable effect of small immune complexes in which antibody is also antigen Br J Rheumatol 1998 37: 126–130

    CAS  PubMed  Google Scholar 

  23. Waters AH . Autoimmune thrombocytopenia: clinical aspects Semin Hematol 1992 29: 18–25

    CAS  PubMed  Google Scholar 

  24. Anasetti C, Rybka W, Sullivan KM et al. Graft-vs-host disease is associated with autoimmune-like thrombocytopenia [see comments] Blood 1989 73: 1054–1058

    CAS  PubMed  Google Scholar 

  25. Sullivan KM, Agura E, Anasetti C et al. Chronic graft-versus-host disease and other late complications of bone marrow transplantation Semin Hematol 1991 28: 250–259

    CAS  PubMed  Google Scholar 

  26. Atkinson K, Horowitz MM, Gale RP et al. Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation Blood 1990 75: 2459–2464

    CAS  PubMed  Google Scholar 

  27. Wagner JL, Flowers ME, Longton G et al. The development of chronic graft-versus-host disease: an analysis of screening studies and the impact of corticosteroid use at 100 days after transplantation Bone Marrow Transplant 1998 22: 139–146

    CAS  PubMed  Google Scholar 

  28. Carlens S, Ringden O, Remberger M et al. Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysis Bone Marrow Transplant 1998 22: 755–761

    CAS  PubMed  Google Scholar 

  29. Eisner MD, August CS . Impact of donor and recipient characteristics on the development of acute and chronic graft-versus-host disease following pediatric bone marrow transplantation Bone Marrow Transplant 1995 15: 663–668

    CAS  PubMed  Google Scholar 

  30. Kollman C, Confer DL, Matlack M et al. The effect of donor age on recipient outcome folowing unrelated donor marrow transplant Blood 1998 92: 686a Abstr. 2827

    Google Scholar 

  31. Ringden O, Remberger M, Ruutu T et al. Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Nordic Bone Marrow Transplantation Group Blood 1999 93: 2196–2201

    CAS  PubMed  Google Scholar 

  32. Blaise D, Maraninchi D, Archimbaud E et al. Allogeneic bone marrow transplantation for acute myeloid leukemia in first remission: a randomized trial of a busulfan–cytoxan versus cytoxan–total body irradiation as preparative regimen: a report from the Group d'Etudes de la Greffe de Moelle Osseuse Blood 1992 79: 2578–2582

    CAS  PubMed  Google Scholar 

  33. Blume KG, Kopecky KJ, Henslee-Downey JP et al. A prospective randomized comparison of total body irradiation–etoposide versus busulfan–cyclophosphamide as preparatory regimens for bone marrow transplantation in patients with leukemia who were not in first remission: a Southwest Oncology Group study Blood 1993 81: 2187–2193

    CAS  PubMed  Google Scholar 

  34. Storek J, Gooley T, Siadak M et al. Allogeneic peripheral blood stem cell transplantation may be associated with a high risk of chronic graft-versus-host disease Blood 1997 90: 4705–4709

    CAS  PubMed  Google Scholar 

  35. Majolino I, Saglio G, Scime R et al. High incidence of chronic GVHD after primary allogeneic peripheral blood stem cell transplantation in patients with hematologic malignancies Bone Marrow Transplant 1996 17: 555–560

    CAS  PubMed  Google Scholar 

  36. Bensinger WI, Martin PJ, Storer B et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers New Engl J Med 2001 344: 175–181

    CAS  PubMed  Google Scholar 

  37. Powles R, Mehta J, Kulkarni S et al. Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases: a randomised trial Lancet 2000 355: 1231–1237

    CAS  PubMed  Google Scholar 

  38. Kottaridis PD, Milligan DW, Chopra R et al. In vivo CAMPATH-1H prevents graft-versus-host disease following nonmyeloablative stem cell transplantation Blood 96: 2419–2425

  39. Atkinson K, Horowitz MM, Gale RP et al. Consensus among bone marrow transplanters for diagnosis, grading and treatment of chronic graft-versus-host disease. Committee of the International Bone Marrow Transplant Registry Bone Marrow Transplant 1989 4: 247–254

    CAS  PubMed  Google Scholar 

  40. Akpek G, Zahurak M, Piantadosi S et al. Development of a prognostic model for grading chronic graft-versus-host disease Blood 2001 97: 1219–1226

    CAS  PubMed  Google Scholar 

  41. Sviland L . The pathology of bone marrow transplantation Curr Diag Pathol 2000 6: 242–250

    Google Scholar 

  42. Artlett CM, Smith JB, Jimenez SA . New perspectives on the etiology of systemic sclerosis Mol Med Today 1999 5: 74–78

    CAS  PubMed  Google Scholar 

  43. Holmes JA, Livesey SJ, Bedwell AE et al. Autoantibody analysis in chronic graft-versus-host disease Bone Marrow Transplant 1989 4: 529–531

    CAS  PubMed  Google Scholar 

  44. Woo SB, Lee SJ, Schubert MM . Graft-vs.-host disease Crit Rev Oral Biol Med 1997 8: 201–216

    CAS  PubMed  Google Scholar 

  45. Seber A, Khan SP, Kersey JH . Unexplained effusions: association with allogeneic bone marrow transplantation and acute or chronic graft-versus-host disease Bone Marrow Transplant 1996 17: 207–211

    CAS  PubMed  Google Scholar 

  46. McDonald GB, Shulman HM, Sullivan KM et al. Intestinal and hepatic complications of human bone marrow transplantation. Part II Gastroenterol 1986 90: 770–784

    CAS  Google Scholar 

  47. DeLord C, Treleaven J, Shepherd J et al. Vaginal stenosis following allogeneic bone marrow transplantation for acute myeloid leukaemia Bone Marrow Transplant 1999 23: 523–525

    CAS  PubMed  Google Scholar 

  48. Corson SL, Sullivan K, Batzer F et al. Gynecologic manifestations of chronic graft-versus-host disease Obstet Gynecol 1982 60: 488–492

    CAS  PubMed  Google Scholar 

  49. Janin A, Socie G, Devergie A et al. Fasciitis in chronic graft-versus-host disease. A clinicopathologic study of 14 cases Ann of Int Med 1994 120: 993–998

    CAS  Google Scholar 

  50. Parker PM, Openshaw H, Forman SJ . Myositis associated with graft-versus-host disease Curr Opin Rheumatol 1997 9: 513–519

    CAS  PubMed  Google Scholar 

  51. Mackey JR, Desai S, Larratt L et al. Myasthenia gravis in association with allogeneic bone marrow transplantation: clinical observations, therapeutic implications and review of literature Bone Marrow Transplant 1997 19: 939–942

    CAS  PubMed  Google Scholar 

  52. Redding SW, Callander NS, Haveman CW et al. Treatment of oral chronic graft-versus-host disease with PUVA therapy: case report and literature review Oral Surg Oral Med Oral Pathol Oral Radiol Endo 1998 86: 183–187

    CAS  Google Scholar 

  53. Nakamura S, Hiroki A, Shinohara M et al. Oral involvement in chronic graft-versus-host disease after allogeneic bone marrow transplantation Oral Surg Oral Med Oral Pathol Oral Radiol Endo 1996 82: 556–563

    CAS  Google Scholar 

  54. Lindahl G, Lonnquist B, Hedfors E . Lymphocytic infiltrations of lip salivary glands in bone marrow recipients A model for the development of the histopathological changes in Sjogren's syndrome? J Autoimmun 1989 2: 579–583

    CAS  Google Scholar 

  55. Manoussakis MN, Moutsopoulos HM . Sjogren's syndrome: autoimmune epithelitis Bailliere Clin Rheumatol 2000 14: 73–95

    CAS  Google Scholar 

  56. Nagler R, Marmary Y, Krausz Y et al. Major salivary gland dysfunction in human acute and chronic graft-versus-host disease (GVHD) Bone Marrow Transplant 1996 17: 219–224

    CAS  PubMed  Google Scholar 

  57. Singhal S, Mehta J, Rattenbury H et al. Oral pilocarpine hydrochloride for the treatment of refractory xerostomia associated with chronic graft-versus-host disease Blood 1995 85: 1147–1148

    CAS  PubMed  Google Scholar 

  58. Vivino FB, Al Hashimi I, Khan Z et al. Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjogren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92–01 Study Group Arc Int Med 1999 159: 174–181

    CAS  Google Scholar 

  59. Aractingi S, Chosidow O . Cutaneous graft-versus-host disease Arch Dermatol 1998 134: 602–612

    CAS  PubMed  Google Scholar 

  60. Kami M, Kanda Y, Sasaki M et al. Phimosis as a manifestation of chronic graft-versus-host disease after allogeneic bone marrow transplantation Bone Marrow Transplant 1998 21: 721–723

    CAS  PubMed  Google Scholar 

  61. Janin-Mercier A, Devergie A, Van Cauwenberge D et al. Immunohistologic and ultrastructural study of the sclerotic skin in chronic graft-versus-host disease in man Am J Pathol 1984 115: 296–306

    CAS  PubMed  PubMed Central  Google Scholar 

  62. Basuk PJ, Scher RK . Onychomycosis in graft versus host disease Cutis 1987 40: 237–241

    CAS  PubMed  Google Scholar 

  63. Franklin RM, Kenyon KR, Tutschka PJ et al. Ocular manifestations of graft-vs-host disease Ophthalmol 1983 90: 4–13

    CAS  Google Scholar 

  64. Shulman HM, Sharma P, Amos D et al. A coded histologic study of hepatic graft-versus-host disease after human bone marrow transplantation Hepatol 1988 8: 463–470

    CAS  Google Scholar 

  65. Strasser SI, Sullivan KM, Myerson D et al. Cirrhosis of the liver in long-term marrow transplant survivors Blood 1999 93: 3259–3266

    CAS  PubMed  Google Scholar 

  66. McDonald GB, Sullivan KM, Schuffler MD et al. Esophageal abnormalities in chronic graft-versus-host disease in humans Gastroenterol 1981 80: 914–921

    CAS  Google Scholar 

  67. Ponec RJ, Saunders MD, Kimmey MB . Neostigmine for the treatment of acute colonic pseudo-obstruction New Engl J Med 1999 341: 137–141

    CAS  PubMed  Google Scholar 

  68. Fisk JD, Shulman HM, Greening RR et al. Gastrointestinal radiographic features of human graft-vs.-host disease Am J Roentgenol 1981 136: 329–336

    CAS  Google Scholar 

  69. Serota FT, Rosenberg HK, Rosen J et al. Delayed onset of gastrointestinal disease in the recipients of bone marrow transplants. A variant graft-versus-host reaction Transplantation 1982 34: 60–64

    CAS  PubMed  Google Scholar 

  70. Pecego R, Hill R, Appelbaum FR et al. Interstitial pneumonitis following autologous bone marrow transplantation Transplantation 1986 42: 515–517

    CAS  PubMed  Google Scholar 

  71. Weiner RS, Bortin MM, Gale RP et al. Interstitial pneumonitis after bone marrow transplantation. Assessment of risk factors Ann Int Med 1986 104: 168–175

    CAS  PubMed  Google Scholar 

  72. Wingard JR, Mellits ED, Sostrin MB et al. Interstitial pneumonitis after allogeneic bone marrow transplantation. Nine-year experience at a single institution Medicine 1988 67: 175–186

    CAS  PubMed  Google Scholar 

  73. Carrigan DR, Drobyski WR, Russler SK, et al . Interstitial pneumonitis associated with human herpesvirus-6 infection after marrow transplantation Lancet 1991 338: 147–149

    CAS  PubMed  Google Scholar 

  74. Cone RW, Hackman RC, Huang ML et al. Human herpesvirus 6 in lung tissue from patients with pneumonitis after bone marrow transplantation [see comments] New Engl J Med 1993 329: 156–161

    CAS  PubMed  Google Scholar 

  75. Cooke KR, Krenger W, Hill G et al. Host reactive donor T cells are associated with lung injury after experimental allogeneic bone marrow transplantation Blood 1998 92: 2571–2580

    CAS  PubMed  Google Scholar 

  76. Ralph DD, Springmeyer SC, Sullivan KM et al. Rapidly progressive air-flow obstruction in marrow transplant recipients. Possible association between obliterative bronchiolitis and chronic graft-versus-host disease Am Rev Resp Dis 1984 129: 641–644

    CAS  PubMed  Google Scholar 

  77. Epler GR . Bronchiolitis obliterans and airways obstruction associated with graft-versus-host disease Clin Chest Med 1988 9: 551–556

    CAS  PubMed  Google Scholar 

  78. Holland HK, Wingard JR, Beschorner WE et al. Bronchiolitis obliterans in bone marrow transplantation and its relationship to chronic graft-v-host disease and low serum IgG Blood 1988 72: 621–627

    CAS  PubMed  Google Scholar 

  79. Ooi GC, Peh WC, Ip M . High-resolution computed tomography of bronchiolitis obliterans syndrome after bone marrow transplantation Respiration 1998 65: 187–191

    CAS  PubMed  Google Scholar 

  80. Clark JG, Crawford SW, Madtes DK et al. Obstructive lung disease after allogeneic marrow transplantation. Clinical presentation and course Ann Int Med 1989 111: 368–376

    CAS  PubMed  Google Scholar 

  81. Openshaw H . Peripheral neuropathy after bone marrow transplantation Biol Blood Marrow Transplant 1997 3: 202–209

    CAS  PubMed  Google Scholar 

  82. Greenspan A, Deeg HJ, Cottler-Fox M et al. Incapacitating peripheral neuropathy as a manifestation of chronic graft-versus-host disease Bone Marrow Transplant 1990 5: 349–352

    CAS  PubMed  Google Scholar 

  83. Gabriel CM, Goldman JM, Lucas S et al. Vasculitic neuropathy in association with chronic graft-versus-host disease J Neurol Sci 1999 168: 68–70

    CAS  PubMed  Google Scholar 

  84. Parker P, Chao NJ, Ben Ezra J et al. Polymyositis as a manifestation of chronic graft-versus-host disease Medicine 1996 75: 279–285

    CAS  PubMed  Google Scholar 

  85. Leber B, Walker IR, Rodriguez A et al. Reinduction of remission of chronic myeloid leukemia by donor leukocyte transfusion following relapse after bone marrow transplantation: recovery complicated by initial pancytopenia and late dermatomyositis Bone Marrow Transplant 1993 12: 405–407

    CAS  PubMed  Google Scholar 

  86. Tse S, Saunders EF, Silverman E et al. Myasthenia gravis and polymyositis as manifestations of chronic graft-versus-host-disease Bone Marrow Transplant 1999 23: 397–399

    CAS  PubMed  Google Scholar 

  87. Bolger GB, Sullivan KM, Spence AM et al. Myasthenia gravis after allogeneic bone marrow transplantation: relationship to chronic graft-versus-host disease Neurology 1986 36: 1087–1091

    CAS  PubMed  Google Scholar 

  88. Smith CI, Aarli JA, Biberfeld P et al. Myasthenia gravis after bone-marrow transplantation. Evidence for a donor origin New Engl J Med 1983 309: 1565–1568

    CAS  PubMed  Google Scholar 

  89. Parker PM, Chao N, Nademanee A et al. Thalidomide as salvage therapy for chronic graft-versus-host disease Blood 1995 86: 3604–3609

    CAS  PubMed  Google Scholar 

  90. Sullivan KM, Witherspoon RP, Storb R et al. Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation Blood 1988 72: 546–554

    CAS  PubMed  Google Scholar 

  91. Atkinson K, Farewell V, Storb R et al. Analysis of late infections after human bone marrow transplantation: role of genotypic nonidentity between marrow donor and recipient and of nonspecific suppressor cells in patients with chronic graft-versus-host disease Blood 1982 60: 714–720

    CAS  PubMed  Google Scholar 

  92. Meyers JD, Atkinson K . Infection in bone marrow transplantation Clin Haematol 1983 12: 791–811

    CAS  PubMed  Google Scholar 

  93. Meyers JD . Infection in bone marrow transplant recipients Am J Med 1986 81: 27–38

    CAS  PubMed  Google Scholar 

  94. Lum LG . The kinetics of immune reconstitution after human marrow transplantation Blood 1987 69: 369–380

    CAS  PubMed  Google Scholar 

  95. Sullivan KM, Meyers JD, Flournoy N et al. Early and late interstitial pneumonia following human bone marrow transplantation Int J Cell Cloning 1986 4: (Suppl. 1) 107–121

    PubMed  Google Scholar 

  96. Kulkarni S, Powles R, Treleaven J et al. Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants Blood 2000 95: 3683–3686

    CAS  PubMed  Google Scholar 

  97. Einsele H, Hebart H, Kauffmann-Schneider C et al. Risk factors for treatment failures in patients receiving PCR-based preemptive therapy for CMV infection Bone Marrow Transplant 2000 25: 757–763

    CAS  PubMed  Google Scholar 

  98. Anonymous Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: recommendations of CDC, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation Biol Blood Marrow Transplant 2000 6: 7–75

  99. Chao NJ, Parker PM, Niland JC et al. Paradoxical effect of thalidomide prophylaxis on chronic graft-vs.-host disease Biol Blood Marrow Transplant 1996 2: 86–92

    CAS  PubMed  Google Scholar 

  100. Papadopoulos EB, Carabasi MH, Castro-Malaspina H et al. T-cell-depleted allogeneic bone marrow transplantation as postremission therapy for acute myelogenous leukemia: freedom from relapse in the absence of graft-versus-host disease Blood 1998 91: 1083–1090

    CAS  PubMed  Google Scholar 

  101. Hale G, Zhang MJ, Bunjes D et al. Improving the outcome of bone marrow transplantation by using CD52 monoclonal antibodies to prevent graft-versus-host disease and graft rejection Blood 1998 92: 4581–4590

    CAS  PubMed  Google Scholar 

  102. Hale G, Jacobs P, Wood L et al. CD52 antibodies for prevention of graft-versus-host disease and graft rejection following transplantation of allogeneic peripheral blood stem cells Bone Marrow Transplantation 2000 26: 69–76

    CAS  PubMed  Google Scholar 

  103. Marmont AM, Horowitz MM, Gale RP et al. T-cell depletion of HLA-identical transplants in leukemia Blood 1991 78: 2120–2130

    CAS  PubMed  Google Scholar 

  104. Sullivan KM, Shulman HM, Storb R et al. Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression Blood 1981 57: 267–276

    CAS  PubMed  Google Scholar 

  105. Sullivan KM, Witherspoon RP, Storb R et al. Alternating-day cyclosporine and prednisone for treatment of high-risk chronic graft-v-host disease Blood 1988 72: 555–561

    CAS  PubMed  Google Scholar 

  106. Carnevale-Schianca F, Martin P, Sullivan K et al. Changing from cyclosporine to tacrolimus as salvage therapy for chronic graft-versus-host disease Biol Blood Marrow Transplant 2000 6: 613–620

    CAS  PubMed  Google Scholar 

  107. Rosenberg ME, Vercellotti GM, Snover DC et al. Bronchiolitis obliterans after bone marrow transplantation Am J Hematol 1985 18: 325–328

    CAS  PubMed  Google Scholar 

  108. Marcellus DC, Altomonte VL, Farmer ER et al. Etretinate therapy for refractory sclerodermatous chronic graft-versus-host disease Blood 1999 93: 66–70

    CAS  PubMed  Google Scholar 

  109. Rovelli A, Arrigo C, Nesi F et al. The role of thalidomide in the treatment of refractory chronic graft-versus-host disease following bone marrow transplantation in children Bone Marrow Transplant 1998 21: 577–581

    CAS  PubMed  Google Scholar 

  110. Vogelsang GB, Farmer ER, Hess AD et al. Thalidomide for the treatment of chronic graft-versus-host disease New Engl J Med 1992 326: 1055–1058

    CAS  PubMed  Google Scholar 

  111. Gilman AL, Chan KW, Mogul A et al. Hydroxychloroquine for the treatment of chronic graft-versus-host disease Biol Blood Marrow Transplant 2000 6: 327–334

    CAS  PubMed  Google Scholar 

  112. Greinix HT, Volc-Platzer B, Rabitsch W et al. Successful use of extracorporeal photochemotherapy in the treatment of severe acute and chronic graft-versus-host disease Blood 1998 92: 3098–3104

    CAS  PubMed  Google Scholar 

  113. Child FJ, Ratnavel R, Watkins P et al. Extracorporeal photopheresis (ECP) in the treatment of chronic graft-versus-host disease (GVHD) Bone Marrow Transplant 1999 23: 881–887

    CAS  PubMed  Google Scholar 

  114. Enk CD, Elad S, Vexler A et al. Chronic graft-versus-host disease treated with UVB phototherapy Bone Marrow Transplant 1998 22: 1179–1183

    CAS  PubMed  Google Scholar 

  115. Vogelsang GB, Wolff D, Altomonte V et al. Treatment of chronic graft-versus-host disease with ultraviolet irradiation and psoralen (PUVA) Bone Marrow Transplant 1996 17: 1061–1067

    CAS  PubMed  Google Scholar 

  116. Koc S, Leisenring W, Flowers ME et al. Thalidomide for treatment of patients with chronic graft-versus-host disease Blood 2000 96: 3995–3996

    CAS  PubMed  Google Scholar 

  117. Krijanovski OI, Hill GR, Cooke KR et al. Keratinocyte growth factor separates graft-versus-leukemia effects from graft-versus-host disease Blood 1999 94: 825–831

    CAS  PubMed  Google Scholar 

  118. Couriel DR, Hicks K, Ippoliti C et al. Infliximab for the treatment of graft-versus-host disease in allogeneic transplant recipients: an update Blood 2001 96: 400a Abstr. 1724

    Google Scholar 

  119. Chiang KY, Marshall C, Abhyankar S et al. Recombinant human soluble tumor necrosis factor receptor fusion protein (Enbrel) as a treatment for chronic graft-versus-host disease (CGvHD) following allogeneic bone marrow transplantation Blood 2001 96: 401a

    Google Scholar 

  120. Edwards JCW, Cambridge G . Sustained improvement in rheumatoid arthritis following a protocol designed to deplete B lymphocytes Rheumatol 2001 40: 205–211

    CAS  Google Scholar 

  121. Ratanatharathorn V, Carson E, Reynolds C et al. Anti-CD20 chimeric monoclonal antibody treatment of refractory immune-mediated thrombocytopenia in a patient with chronic graft-versus-host disease Ann Int Med 2000 133: 275–279

    CAS  PubMed  Google Scholar 

  122. Zaja F, Russo D, Fuga G, et al . Rituximab for myasthenia gravis developing after bone marrow transplant Neurology 2000 55: 1062–1063

    CAS  PubMed  Google Scholar 

  123. Browne PV, Weisdorf DJ, DeFor T et al. Response to thalidomide therapy in refractory chronic graft-versus-host disease Bone Marrow Transplant 2000 26: 865–869

    CAS  PubMed  Google Scholar 

  124. Gaziev D, Lucarelli G, Polchi P et al. A three or more drug combination as effective therapy for moderate or severe chronic graft-versus-host disease Bone Marrow Transplant 2001 27: 45–51

    CAS  PubMed  Google Scholar 

  125. Lee SJ, Wegner SA, McGarigle CJ et al. Treatment of chronic graft-versus-host disease with clofazimine Blood 1997 89: 2298–2302

    CAS  PubMed  Google Scholar 

  126. Mookerjee B, Altomonte V, Vogelsang G . Salvage therapy for refractory chronic graft-versus-host disease with mycophenolate mofetil and tacrolimus Bone Marrow Transplant 1999 24: 517–520

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Blood and Marrow Stem Cell Transplantation Programs at University of Michigan Medical Center, Ann Arbor, MI, USA

    V Ratanatharathorn, L Ayash, J Fu & JP Uberti

  2. Blood and Marrow Stem Cell Transplantation Programs at Comprehensive Cancer Center of the University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA

    HM Lazarus

Authors
  1. V Ratanatharathorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L Ayash
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. HM Lazarus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. JP Uberti
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ratanatharathorn, V., Ayash, L., Lazarus, H. et al. Chronic graft-versus-host disease: clinical manifestation and therapy. Bone Marrow Transplant 28, 121–129 (2001). https://doi.org/10.1038/sj.bmt.1703111

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1703111

Keywords

This article is cited by

Search

Advanced search

Quick links