Skip to main content

Graft-Versus-Host Disease

  • Chapter
  • First Online:
Buka's Emergencies in Dermatology

Abstract

Graft-versus-host disease (GVHD) is a multisystem disorder combining features of both autoimmunity and immunodeficiency. It is a common and serious complication of hematopoietic stem cell transplantation (HSCT), and rarely solid organ transplantation, transfusion, and donor lymphocyte infusion. Because of its complex pathophysiology and diverse clinical manifestations, management of this challenging disease requires a multidisciplinary approach. Skin findings are the most common presenting sign, and they found in all forms of GVHD; therefore, the dermatologist plays an important role in diagnosis and therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mathe G, Amiel JL, Schwarzenberg L, Cattan A, Schneider M. Adoptive immunotherapy of acute leukemia: experimental and clinical results. Cancer Res. 1965;25:1525–31.

    PubMed  CAS  Google Scholar 

  2. Sorror ML, Sandmaier BM, Storer BE, Franke GN, Laport GG, Chauncey TR, et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA. 2011;306:1874–83.

    Article  PubMed  CAS  Google Scholar 

  3. Ahmed SO, Ghavamzadeh A, Zaidi SZ, Baldomero H, Pasquini MC, Hussain F, et al. Trends of hematopoietic stem cell transplantation in the Eastern Mediterranean region, 1984–2007. Biol Blood Marrow Transplant. 2011;17:1352–61.

    Article  PubMed  Google Scholar 

  4. Zhang H, Chen J, Que W. Allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials. Leuk Res. 2011;36(4):431–7.

    Article  PubMed  Google Scholar 

  5. Bensinger WI. Allogeneic transplantation: peripheral blood vs. bone marrow. Curr Opin Oncol. 2011;24(2):191–6.

    Article  Google Scholar 

  6. Rocha V, Gluckman E. Clinical use of umbilical cord blood hematopoietic stem cells. Biol Blood Marrow Transplant. 2006;12:34–41.

    Article  PubMed  Google Scholar 

  7. Cohen Y, Nagler A. Umbilical cord blood transplantation–how, when and for whom? Blood Rev. 2004;18:167–79.

    Article  PubMed  Google Scholar 

  8. Bertaina A, Bernardo ME, Caniglia M, Vinti L, Giorgiani G, Locatelli F. Cord blood transplantation in children with haematological malignancies. Best Pract Res Clin Haematol. 2010;23:189–96.

    Article  PubMed  Google Scholar 

  9. Saliba RM, de Lima M, Giralt S, Andersson B, Khouri IF, Hosing C, et al. Hyperacute GVHD: risk factors, outcomes, and clinical implications. Blood. 2007;109:2751–8.

    PubMed  CAS  Google Scholar 

  10. Peggs KS, Aviva K, Mackall CL. Clinical implications of immune reconstitution following hematopoietic stem cell transplantation. In: Bishop MR, editor. Hematopoietic stem cell transplantation. New York: Springer; 2009. p. xv. 589 p.

    Google Scholar 

  11. Jang JE, Hyun SY, Kim YD, Yoon SH, Hwang DY, Kim SJ, et al. Risk factors for progression from cytomegalovirus viremia to cytomegalovirus disease after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2011;18(6):881–6.

    Article  PubMed  Google Scholar 

  12. Kashiwazaki H, Matsushita T, Sugita J, Shigematsu A, Kasashi K, Yamazaki Y, et al. A comparison of oral mucositis in allogeneic hematopoietic stem cell transplantation between conventional and reduced-intensity regimens. Support Care Cancer. 2011;20(5):933–9.

    Article  PubMed  Google Scholar 

  13. McDiarmid S. Nutritional support of the patient receiving high-dose therapy with hematopoietic stem cell support. Can Oncol Nurs J. 2002;12:102–15.

    PubMed  Google Scholar 

  14. Arfons LM, Lazarus HM. Total parenteral nutrition and hematopoietic stem cell transplantation: an expensive placebo? Bone Marrow Transplant. 2005;36:281–8.

    Article  PubMed  CAS  Google Scholar 

  15. McNeer JL, Kletzel M, Rademaker A, Alford K, O’Day K, Schaefer C, et al. Early elevation of C-reactive protein correlates with severe infection and nonrelapse mortality in children undergoing allogeneic stem cell transplantation. Biol Blood Marrow Transplant. 2010;16:350–7.

    Article  PubMed  CAS  Google Scholar 

  16. Agarwal S, O’Donoghue S, Gowardman J, Kennedy G, Bandeshe H, Boots R. Intensive care unit experience of hematopoietic stem cell transplant patients. Intern Med J. 2011;42(7):748–54.

    Article  Google Scholar 

  17. Wingard JR, Hsu J, Hiemenz JW. Hematopoietic stem cell transplantation: an overview of infection risks and epidemiology. Infect Dis Clin North Am. 2010;24:257–72.

    Article  PubMed  Google Scholar 

  18. Cavazzana-Calvo M, Andre-Schmutz I, Dal Cortivo L, Neven B, Hacein-Bey-Abina S, Fischer A. Immune reconstitution after haematopoietic stem cell transplantation: obstacles and anticipated progress. Curr Opin Immunol. 2009;21:544–8.

    Article  PubMed  CAS  Google Scholar 

  19. Choi SW, Levine JE, Ferrara JL. Pathogenesis and management of graft-versus-host disease. Immunol Allergy Clin North Am. 2010;30:75–101.

    Article  PubMed  Google Scholar 

  20. Penas PF, Zaman S. Many faces of graft-versus-host disease. Australas J Dermatol. 2010;51:1–10. quiz 1.

    Article  PubMed  Google Scholar 

  21. Billingham RE. The biology of graft-versus-host reactions. Harvey Lect. 1966;62:21–78.

    PubMed  Google Scholar 

  22. Spencer CT, Gilchuk P, Dragovic SM, Joyce S. Minor histocompatibility antigens: presentation principles, recognition logic and the potential for a healing hand. Curr Opin Organ Transplant. 2010;15:512–25.

    Article  PubMed  Google Scholar 

  23. Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2:35.

    Article  PubMed  Google Scholar 

  24. Duret L, Galtier N. Biased gene conversion and the evolution of mammalian genomic landscapes. Annu Rev Genomics Hum Genet. 2009;10:285–311.

    Article  PubMed  CAS  Google Scholar 

  25. Bleakley M, Riddell SR. Exploiting T cells specific for human minor histocompatibility antigens for therapy of leukemia. Immunol Cell Biol. 2011;89:396–407.

    Article  PubMed  CAS  Google Scholar 

  26. Gratwohl A, Hermans J, Niederwieser D, van Biezen A, van Houwelingen HC, Apperley J. Female donors influence transplant-related mortality and relapse incidence in male recipients of sibling blood and marrow transplants. Hematol J. 2001;2:363–70.

    Article  PubMed  CAS  Google Scholar 

  27. Goker H, Haznedaroglu IC, Chao NJ. Acute graft-vs-host disease: pathobiology and management. Exp Hematol. 2001;29:259–77.

    Article  PubMed  CAS  Google Scholar 

  28. Bleakley M, Riddell SR. Molecules and mechanisms of the graft-versus-leukaemia effect. Nat Rev Cancer. 2004;4:371–80.

    Article  PubMed  CAS  Google Scholar 

  29. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005;11:945–56.

    Article  PubMed  Google Scholar 

  30. Ferrara JL, Levine JE, Reddy P, Holler E. Graft-versus-host disease. Lancet. 2009;373:1550–61.

    Article  PubMed  CAS  Google Scholar 

  31. Ferrara JL, Levine JE. Graft-versus-host disease in the 21st century: new perspectives on an old problem. Semin Hematol. 2006;43:1–2.

    Article  PubMed  Google Scholar 

  32. Cooke KR, Olkiewicz K, Erickson N, Ferrara JL. The role of endotoxin and the innate immune response in the pathophysiology of acute graft versus host disease. J Endotoxin Res. 2002;8:441–8.

    PubMed  CAS  Google Scholar 

  33. Liu D, Yan C, Xu L, Wang Y, Han W, Zhang X, et al. Diarrhea during the conditioning regimen is correlated with the occurrence of severe acute graft-versus-host disease through systemic release of inflammatory cytokines. Biol Blood Marrow Transplant. 2010;16:1567–75.

    Article  PubMed  Google Scholar 

  34. Penack O, Holler E, van den Brink MR. Graft-versus-host disease: regulation by microbe-associated molecules and innate immune receptors. Blood. 2010;115:1865–72.

    Article  PubMed  CAS  Google Scholar 

  35. Reddy P, Ferrara JLM. Pathophysiology of graft-versus-host disease. In: Soiffer RJ, editor. Hematopoietic stem cell transplantation. Totowa, NJ: Humana, Springer distributor; 2008. p. xvi. 736 p.

    Google Scholar 

  36. Washington K, Jagasia M. Pathology of graft-versus-host disease in the gastrointestinal tract. Hum Pathol. 2009;40:909–17.

    Article  PubMed  Google Scholar 

  37. Varkila K, Hurme M. Natural killer (NK) cells and graft-versus-host disease (GVHD): no correlation between the NK cell levels and GVHD in the murine P––F1 model. Immunology. 1985;54:121–6.

    PubMed  CAS  Google Scholar 

  38. Olson JA, Leveson-Gower DB, Gill S, Baker J, Beilhack A, Negrin RS. NK cells mediate reduction of GVHD by inhibiting activated, alloreactive T cells while retaining GVT effects. Blood. 2010;115:4293–301.

    Article  PubMed  CAS  Google Scholar 

  39. Noval Rivas M, Hazzan M, Weatherly K, Gaudray F, Salmon I, Braun MY. NK cell regulation of CD4 T cell-mediated graft-versus-host disease. J Immunol. 2010;184:6790–8.

    Article  PubMed  CAS  Google Scholar 

  40. Tanaka M, Kobayashi S, Numata A, Tachibana T, Takasaki H, Maruta A, et al. The impact of the dose of natural killer cells in the graft on severe acute graft-versus-host disease after unrelated bone marrow transplantation. Leuk Res. 2011;36(6):699–703.

    Article  PubMed  Google Scholar 

  41. Thomas ED, Storb R, Clift RA, Fefer A, Johnson L, Neiman PE, et al. Bone-marrow transplantation (second of two parts). N Engl J Med. 1975;292:895–902.

    Article  PubMed  CAS  Google Scholar 

  42. Rapini RP. Practical dermatopathology. St. Louis, MO: Elsevier Mosby; 2005.

    Google Scholar 

  43. Deeg HJ, Antin JH. The clinical spectrum of acute graft-versus-host disease. Semin Hematol. 2006;43:24–31.

    Article  PubMed  Google Scholar 

  44. Ross WA, Couriel D. Colonic graft-versus-host disease. Curr Opin Gastroenterol. 2005;21:64–9.

    PubMed  Google Scholar 

  45. Hausermann P, Walter RB, Halter J, Biedermann BC, Tichelli A, Itin P, et al. Cutaneous graft-versus-host disease: a guide for the dermatologist. Dermatology. 2008;216:287–304.

    Article  PubMed  Google Scholar 

  46. Byun HJ, Yang JI, Kim BK, Cho KH. Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions. J Am Acad Dermatol. 2011;65:726–32.

    Article  PubMed  Google Scholar 

  47. Benesch M, Deeg HJ. Pathophysiology of graft-versus-host disease. In: Soiffer RJ, editor. Hematopoietic stem cell transplantation. Totowa, NJ: Humana; Springer distributor; 2008. p. xvi. 736 p.

    Google Scholar 

  48. Tani M, Adachi A. Acute follicular graft-versus-host disease. Dermatology. 1992;185:281–3.

    Article  PubMed  CAS  Google Scholar 

  49. Friedman KJ, LeBoit PE, Farmer ER. Acute follicular graft-vs-host reaction. A distinct clinicopathologic presentation. Arch Dermatol. 1988;124:688–91.

    Article  PubMed  CAS  Google Scholar 

  50. Chaudhuri SP, Smoller BR. Acute cutaneous graft versus host disease: a clinicopathologic and immunophenotypic study. Int J Dermatol. 1992;31:270–2.

    Article  PubMed  CAS  Google Scholar 

  51. Goiriz R, Penas P, Perez-Gala S, Delgado-Jimenez Y, Aragues M, Garcia-Diez A, et al. Stage IV cutaneous acute graft-versus-host disease. Clinical and histological study of 15 cases. J Eur Acad Dermatol Venereol. 2009;23:1398–404.

    Article  PubMed  CAS  Google Scholar 

  52. McDonald GB. Review article: management of hepatic disease following haematopoietic cell transplant. Aliment Pharmacol Ther. 2006;24:441–52.

    Article  PubMed  CAS  Google Scholar 

  53. McDonald GB. Hepatobiliary complications of hematopoietic cell transplantation, 40 years on. Hepatology. 2010;51:1450–60.

    Article  PubMed  Google Scholar 

  54. Levitsky J, Sorrell MF. Hepatic complications of hematopoietic cell transplantation. Curr Gastroenterol Rep. 2007;9:60–5.

    Article  PubMed  Google Scholar 

  55. Ross WA, Ghosh S, Dekovich AA, Liu S, Ayers GD, Cleary KR, et al. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol. 2008;103:982–9.

    Article  PubMed  Google Scholar 

  56. Nishio N, Yagasaki H, Takahashi Y, Hama A, Muramatsu H, Tanaka M, et al. Engraftment syndrome following allogeneic hematopoietic stem cell transplantation in children. Pediatr Transplant. 2009;13:831–7.

    Article  PubMed  CAS  Google Scholar 

  57. Carreras E, Fernandez-Aviles F, Silva L, Guerrero M, Fernandez de Larrea C, Martinez C, et al. Engraftment syndrome after auto-SCT: analysis of diagnostic criteria and risk factors in a large series from a single center. Bone Marrow Transplant. 2010;45:1417–22.

    Article  PubMed  CAS  Google Scholar 

  58. Dai E, Couriel D, Kim SK. Bilateral marginal keratitis associated with engraftment syndrome after hematopoietic stem cell transplantation. Cornea. 2007;26:756–8.

    Article  PubMed  Google Scholar 

  59. Schmid I, Stachel D, Pagel P, Albert MH. Incidence, predisposing factors, and outcome of engraftment syndrome in pediatric allogeneic stem cell transplant recipients. Biol Blood Marrow Transplant. 2008;14:438–44.

    Article  PubMed  Google Scholar 

  60. Koreth J, Biernacki M, Aldridge J, Kim HT, Alyea III EP, Armand P, et al. Syngeneic donor hematopoietic stem cell transplantation is associated with high rates of engraftment syndrome. Biol Blood Marrow Transplant. 2011;17:421–8.

    Article  PubMed  Google Scholar 

  61. Hood AF, Vogelsang GB, Black LP, Farmer ER, Santos GW. Acute graft-vs-host disease. Development following autologous and syngeneic bone marrow transplantation. Arch Dermatol. 1987;123:745–50.

    Article  PubMed  CAS  Google Scholar 

  62. Hess AD. Autologous graft-versus-host disease. J Hematother Stem Cell Res. 2000;9:297.

    Article  PubMed  CAS  Google Scholar 

  63. Hess AD. Modulation of graft-versus-host disease: role of regulatory T lymphocytes. Biol Blood Marrow Transplant. 2006;12:13–21.

    Article  PubMed  Google Scholar 

  64. Kline J, Subbiah S, Lazarus HM, van Besien K. Autologous graft-versus-host disease: harnessing anti-tumor immunity through impaired self-tolerance. Bone Marrow Transplant. 2008;41:505–13.

    Article  PubMed  CAS  Google Scholar 

  65. Jenkins MK, Schwartz RH, Pardoll DM. Effects of cyclosporine A on T cell development and clonal deletion. Science. 1988;241:1655–8.

    Article  PubMed  CAS  Google Scholar 

  66. Bolanos-Meade J, Garrett-Mayer E, Luznik L, Anders V, Webb J, Fuchs EJ, et al. Induction of autologous graft-versus-host disease: results of a randomized prospective clinical trial in patients with poor risk lymphoma. Biol Blood Marrow Transplant. 2007;13:1185–91.

    Article  PubMed  CAS  Google Scholar 

  67. Zhang Y, Ruiz P. Solid organ transplant-associated acute graft-versus-host disease. Arch Pathol Lab Med. 2010;134:1220–4.

    PubMed  Google Scholar 

  68. Kohler S, Pascher A, Junge G, Sauer IM, Nagy M, Schonemann C, et al. Graft versus host disease after liver transplantation—a single center experience and review of literature. Transpl Int. 2008;21:441–51.

    Article  PubMed  CAS  Google Scholar 

  69. Shin CR, Nathan J, Alonso M, Yazigi N, Kocoshis S, Tiao G, et al. Incidence of acute and chronic graft-versus-host disease and donor T-cell chimerism after small bowel or combined organ transplantation. J Pediatr Surg. 2011;46:1732–8.

    Article  PubMed  Google Scholar 

  70. Taylor AL, Gibbs P, Bradley JA. Acute graft versus host disease following liver transplantation: the enemy within. Am J Transplant. 2004;4:466–74.

    Article  PubMed  Google Scholar 

  71. Assi MA, Pulido JS, Peters SG, McCannel CA, Razonable RR. Graft-vs.-host disease in lung and other solid organ transplant recipients. Clin Transplant. 2007;21:1–6.

    Article  PubMed  Google Scholar 

  72. Walling HW, Voigt MD, Stone MS. Lichenoid graft vs. host disease following liver transplantation. J Cutan Pathol. 2004;31:179–84.

    Article  PubMed  Google Scholar 

  73. Schrager JJ, Vnencak-Jones CL, Graber SE, Neff AT, Chari RS, Wright Jr KJ, et al. Use of short tandem repeats for DNA fingerprinting to rapidly diagnose graft-versus-host disease in solid organ transplant patients. Transplantation. 2006;81:21–5.

    Article  PubMed  CAS  Google Scholar 

  74. Ruhl H, Bein G, Sachs UJ. Transfusion-associated graft-versus-host disease. Transfus Med Rev. 2009;23:62–71.

    Article  PubMed  Google Scholar 

  75. Linden JV, Pisciotto PT. Transfusion-associated graft-versus-host disease and blood irradiation. Transfus Med Rev. 1992;6:116–23.

    Article  PubMed  CAS  Google Scholar 

  76. Agbaht K, Altintas ND, Topeli A, Gokoz O, Ozcebe O. Transfusion-associated graft-versus-host disease in immunocompetent patients: case series and review of the literature. Transfusion. 2007;47:1405–11.

    Article  PubMed  Google Scholar 

  77. Parshuram C, Doyle J, Lau W, Shemie SD. Transfusion-associated graft versus host disease. Pediatr Crit Care Med. 2002;3:57–62.

    Article  PubMed  Google Scholar 

  78. Bashir S, Naik F, Cardigan R, Thomas S. Effect of X-irradiation on the quality of red cell concentrates. Vox Sang. 2011;101:200–7.

    Article  PubMed  CAS  Google Scholar 

  79. Frey NV, Porter DL. Graft-versus-host disease after donor leukocyte infusions: presentation and management. Best Pract Res Clin Haematol. 2008;21:205–22.

    Article  PubMed  CAS  Google Scholar 

  80. Porter D, Hexner EO, Cooley S, Miller JS. Cellular adoptive immunotherapy after autologous and allogeneic hematopoietic stem cell transplantation. In: Bishop MR, editor. Hematopoietic stem cell transplantation. New York: Springer; 2008.

    Google Scholar 

  81. Chalandon Y, Passweg JR, Schmid C, Olavarria E, Dazzi F, Simula MP, et al. Outcome of patients developing GVHD after DLI given to treat CML relapse: a study by the Chronic Leukemia Working Party of the EBMT. Bone Marrow Transplant. 2010;45:558–64.

    Article  PubMed  CAS  Google Scholar 

  82. Porter D, Levine JE. Graft-versus-host disease and graft-versus-leukemia after donor leukocyte infusion. Semin Hematol. 2006;43:53–61.

    Article  PubMed  Google Scholar 

  83. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974;18:295–304.

    Article  PubMed  CAS  Google Scholar 

  84. Cahn JY, Klein JP, Lee SJ, Milpied N, Blaise D, Antin JH, et al. Prospective evaluation of 2 acute graft-versus-host (GVHD) grading systems: a joint Societe Francaise de Greffe de Moelle et Therapie Cellulaire (SFGM-TC), Dana Farber Cancer Institute (DFCI), and International Bone Marrow Transplant Registry (IBMTR) prospective study. Blood. 2005;106:1495–500.

    Article  PubMed  CAS  Google Scholar 

  85. Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ, et al. IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol. 1997;97:855–64.

    Article  PubMed  CAS  Google Scholar 

  86. Martino R, Romero P, Subira M, Bellido M, Altes A, Sureda A, et al. Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow Transplant Registry. Bone Marrow Transplant. 1999;24:283–7.

    Article  PubMed  CAS  Google Scholar 

  87. Carpenter PA, Lowder J, Johnston L, Frangoul H, Khoury H, Parker P, et al. A phase II multicenter study of visilizumab, humanized anti-CD3 antibody, to treat steroid-refractory acute graft-versus-host disease. Biol Blood Marrow Transplant. 2005;11:465–71.

    Article  PubMed  CAS  Google Scholar 

  88. Min CK. The pathophysiology of chronic graft-versus-host disease: the unveiling of an enigma. Korean J Hematol. 2011;46:80–7.

    Article  PubMed  CAS  Google Scholar 

  89. Arora M, Klein JP, Weisdorf DJ, Hassebroek A, Flowers ME, Cutler CS, et al. Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis. Blood. 2011;117:6714–20.

    Article  PubMed  CAS  Google Scholar 

  90. Shimabukuro-Vornhagen A, Hallek MJ, Storb RF, von Bergwelt-Baildon MS. The role of B cells in the pathogenesis of graft-versus-host disease. Blood. 2009;114:4919–27.

    Article  PubMed  CAS  Google Scholar 

  91. Koreth J, Matsuoka K, Kim HT, McDonough SM, Bindra B, Alyea III EP, et al. Interleukin-2 and regulatory T cells in graft-versus-host disease. N Engl J Med. 2011;365:2055–66.

    Article  PubMed  CAS  Google Scholar 

  92. Carlens S, Ringden O, Remberger M, Lonnqvist B, Hagglund H, Klaesson S, et al. Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysis. Bone Marrow Transplant. 1998;22:755–61.

    Article  PubMed  CAS  Google Scholar 

  93. Pidala J, Vogelsang G, Martin P, Chai X, Storer B, Pavletic S, et al. Overlap subtype of chronic graft vs. host disease is associated with adverse prognosis, functional impairment, and inferior patient reported outcomes: a chronic graft vs. host disease Consortium study. Haematologica. 2012;97:451–8.

    Article  PubMed  Google Scholar 

  94. Martires KJ, Baird K, Steinberg SM, Grkovic L, Joe GO, Williams KM, et al. Sclerotic-type chronic GVHD of the skin: clinical risk factors, laboratory markers, and burden of disease. Blood. 2011;118:4250–7.

    Article  PubMed  CAS  Google Scholar 

  95. Martires KJ, Baird K, Citrin DE, Hakim FT, Pavletic SZ, Cowen EW. Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury: potential insight into the mechanism of isomorphic and isotopic responses. Arch Dermatol. 2011;147:1081–6.

    Article  PubMed  Google Scholar 

  96. Mehra T, Metzler G, Bauer J, Koberle M, Garbe C. Isotopic response of graft versus host disease following Herpes Zoster infection: case report and review of the literature. Acta Derm Venereol. 2012;92(4):383–4.

    PubMed  Google Scholar 

  97. Aractingi S, Chosidow O. Cutaneous graft-versus-host disease. Arch Dermatol. 1998;134:602–12.

    Article  PubMed  CAS  Google Scholar 

  98. Kfoury HK, Alghonaim M, AlSuwaida AK, Zaidi SN, Arafah M. Nasopharyngeal T-cell monomorphic posttransplant lymphoproliferative disorders and combined IgA nephropathy and membranous glomerulonephritis in a patient with renal transplantation: a case report with literature review. Transplant Proc. 2010;42:4653–7.

    Article  PubMed  CAS  Google Scholar 

  99. Resende RG, de Fatima Correia-Silva J, Arao TC, Brito JA, Bittencourt H, Gomez RS, et al. Oral cGVHD screening tests in the diagnosis of systemic chronic graft-versus-host disease. Clin Oral Investig. 2012;16(2):565–70.

    Article  PubMed  Google Scholar 

  100. Nagler R, Marmary Y, Krausz Y, Chisin R, Markitziu A, Nagler A. Major salivary gland dysfunction in human acute and chronic graft-versus-host disease (GVHD). Bone Marrow Transplant. 1996;17:219–24.

    PubMed  CAS  Google Scholar 

  101. Koch KR, Joussen AM, Huber KK. Ocular involvement in chronic graft-versus-host disease: therapeutic approaches to complicated courses. Cornea. 2011;30:107–13.

    Article  PubMed  Google Scholar 

  102. Sanli H, Arat M, Oskay T, Gurman G. Evaluation of nail involvement in patients with chronic cutaneous graft versus host disease: a single-center study from Turkey. Int J Dermatol. 2004;43:176–80.

    Article  PubMed  Google Scholar 

  103. Akay BN, Sanli H, Topcuoglu P, Arat M, Akyol A. Nailfold capillary abnormalities are prevalent in sclerodermoid graft-versus-host disease and readily detected with dermatoscopy. Br J Dermatol. 2010;162:1076–82.

    Article  PubMed  CAS  Google Scholar 

  104. Arai S, Jagasia M, Storer B, Chai X, Pidala J, Cutler C, et al. Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood. 2011;118:4242–9.

    Article  PubMed  CAS  Google Scholar 

  105. Kuzmina Z, Eder S, Bohm A, Pernicka E, Vormittag L, Kalhs P, et al. Significantly worse survival of patients with NIH-defined chronic graft-versus-host disease and thrombocytopenia or progressive onset type: results of a prospective study. Leukemia. 2011;26(4):746–56.

    Article  PubMed  CAS  Google Scholar 

  106. Ahmad I, Labbe AC, Chagnon M, Busque L, Cohen S, Kiss T, et al. Incidence and prognostic value of eosinophilia in chronic graft-versus-host disease after nonmyeloablative hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2011;17:1673–8.

    Article  PubMed  Google Scholar 

  107. Schroeder MA, DiPersio JF. Mouse models of graft-versus-host disease: advances and limitations. Dis Model Mech. 2011;4:318–33.

    Article  PubMed  CAS  Google Scholar 

  108. Chu YW, Gress RE. Murine models of chronic graft-versus-host disease: insights and unresolved issues. Biol Blood Marrow Transplant. 2008;14:365–78.

    Article  PubMed  CAS  Google Scholar 

  109. Zhang C, Todorov I, Zhang Z, Liu Y, Kandeel F, Forman S, et al. Donor CD4+ T and B cells in transplants induce chronic graft-versus-host disease with autoimmune manifestations. Blood. 2006;107:2993–3001.

    Article  PubMed  CAS  Google Scholar 

  110. Rezvani K, Mielke S, Ahmadzadeh M, Kilical Y, Savani BN, Zeilah J, et al. High donor FOXP3-positive regulatory T-cell (Treg) content is associated with a low risk of GVHD following HLA-matched allogeneic SCT. Blood. 2006;108:1291–7.

    Article  PubMed  CAS  Google Scholar 

  111. Heshmati F. Extra corporeal photo chemotherapy (ECP) in acute and chronic GVHD. Transfus Apher Sci. 2010;43:211–5.

    Article  PubMed  Google Scholar 

  112. Perruche S, Marandin A, Kleinclauss F, Angonin R, Fresnay S, Baron MH, et al. Association of mixed hematopoietic chimerism with elevated circulating autoantibodies and chronic graft-versus-host disease occurrence. Transplantation. 2006;81:573–82.

    Article  PubMed  Google Scholar 

  113. Socie G. Chronic GVHD: B cells come of age. Blood. 2011;117:2086–7.

    Article  PubMed  CAS  Google Scholar 

  114. Kharfan-Dabaja MA, Cutler CS. Rituximab for prevention and treatment of graft-versus-host disease. Int J Hematol. 2011;93:578–85.

    Article  PubMed  CAS  Google Scholar 

  115. Rozmus J, Schultz KR. Biomarkers in chronic graft-versus-host disease. Expert Rev Hematol. 2011;4:329–42.

    Article  PubMed  CAS  Google Scholar 

  116. Fujii H, Cuvelier G, She K, Aslanian S, Shimizu H, Kariminia A, et al. Biomarkers in newly diagnosed pediatric-extensive chronic graft-versus-host disease: a report from the Children’s Oncology Group. Blood. 2008;111:3276–85.

    Article  PubMed  CAS  Google Scholar 

  117. Svegliati S, Olivieri A, Campelli N, Luchetti M, Poloni A, Trappolini S, et al. Stimulatory autoantibodies to PDGF receptor in patients with extensive chronic graft-versus-host disease. Blood. 2007;110:237–41.

    Article  PubMed  CAS  Google Scholar 

  118. Kim SJ, Won JH. B cell homeostasis and the development of chronic graft-versus-host disease: implications for B cell-depleting therapy. Leuk Lymphoma. 2012;53:19–25.

    Article  PubMed  CAS  Google Scholar 

  119. Skert C, Damiani D, Michelutti A, Patriarca F, Arpinati M, Fili C, et al. Kinetics of Th1/Th2 cytokines and lymphocyte subsets to predict chronic GVHD after allo-SCT: results of a prospective study. Bone Marrow Transplant. 2009;44:729–37.

    Article  PubMed  CAS  Google Scholar 

  120. Kansu E. The pathophysiology of chronic graft-versus-host disease. Int J Hematol. 2004;79:209–15.

    Article  PubMed  Google Scholar 

  121. Liem LM, Fibbe WE, van Houwelingen HC, Goulmy E. Serum transforming growth factor-beta1 levels in bone marrow transplant recipients correlate with blood cell counts and chronic graft-versus-host disease. Transplantation. 1999;67:59–65.

    Article  PubMed  CAS  Google Scholar 

  122. Murata T, Husain SR, Mohri H, Puri RK. Two different IL-13 receptor chains are expressed in normal human skin fibroblasts, and IL-4 and IL-13 mediate signal transduction through a common pathway. Int Immunol. 1998;10:1103–10.

    Article  PubMed  CAS  Google Scholar 

  123. Atkinson K, Horowitz MM, Gale RP, van Bekkum DW, Gluckman E, Good RA, et al. Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation. Blood. 1990;75:2459–64.

    PubMed  CAS  Google Scholar 

  124. Curtis RE, Rowlings PA, Deeg HJ, Shriner DA, Socie G, Travis LB, et al. Solid cancers after bone marrow transplantation. N Engl J Med. 1997;336:897–904.

    Article  PubMed  CAS  Google Scholar 

  125. Epaulard O, Leccia MT, Blanche S, Chosidow O, Mamzer-Bruneel MF, Ravaud P, et al. Phototoxicity and photocarcinogenesis associated with voriconazole. Med Mal Infect. 2011;41:639–45.

    Article  PubMed  CAS  Google Scholar 

  126. Clancy CJ, Nguyen MH. Long-term voriconazole and skin cancer: is there cause for concern? Curr Infect Dis Rep. 2011;13:536–43.

    Article  PubMed  Google Scholar 

  127. Vadnerkar A, Nguyen MH, Mitsani D, Crespo M, Pilewski J, Toyoda Y, et al. Voriconazole exposure and geographic location are independent risk factors for squamous cell carcinoma of the skin among lung transplant recipients. J Heart Lung Transplant. 2010;29:1240–4.

    Article  PubMed  Google Scholar 

  128. Ibrahim SF, Singer JP, Arron ST. Catastrophic squamous cell carcinoma in lung transplant patients treated with voriconazole. Dermatol Surg. 2010;36:1752–5.

    Article  PubMed  CAS  Google Scholar 

  129. Vanacker A, Fabre G, Van Dorpe J, Peetermans WE, Maes B. Aggressive cutaneous squamous cell carcinoma associated with prolonged voriconazole therapy in a renal transplant patient. Am J Transplant. 2008;8:877–80.

    Article  PubMed  CAS  Google Scholar 

  130. McCarthy KL, Playford EG, Looke DF, Whitby M. Severe photosensitivity causing multifocal squamous cell carcinomas secondary to prolonged voriconazole therapy. Clin Infect Dis. 2007;44:e55–6.

    Article  PubMed  CAS  Google Scholar 

  131. Marks C, Stadler M, Hausermann P, Wolff D, Buchholz S, Stary G, et al. German-Austrian-Swiss Consensus Conference on clinical practice in chronic graft-versus-host disease (GVHD): guidance for supportive therapy of chronic cutaneous and musculoskeletal GVHD. Br J Dermatol. 2011;165:18–29.

    Article  PubMed  CAS  Google Scholar 

  132. Couriel DR. Ancillary and supportive care in chronic graft-versus-host disease. Best Pract Res Clin Haematol. 2008;21:291–307.

    Article  PubMed  Google Scholar 

  133. Couriel DR, Beguelin GZ, Giralt S, De Lima M, Hosing C, Kharfan-Dabaja MA, et al. Chronic graft-versus-host disease manifesting as polymyositis: an uncommon presentation. Bone Marrow Transplant. 2002;30:543–6.

    Article  PubMed  CAS  Google Scholar 

  134. Ahn JS, Cho SH, Kim YK, Yang DH, Bae WK, Shim HJ, et al. Polymyositis and myocarditis after donor lymphocyte infusion. Int J Hematol. 2009;90:113–6.

    Article  PubMed  Google Scholar 

  135. Hilgendorf I, Freund M, Jilg W, Einsele H, Gea-Banacloche J, Greinix H, et al. Vaccination of allogeneic haematopoietic stem cell transplant recipients: report from the international consensus conference on clinical practice in chronic GVHD. Vaccine. 2011;29:2825–33.

    Article  PubMed  Google Scholar 

  136. Ziemer M, Gruhn B, Thiele JJ, Elsner P. Treatment of extensive chronic cutaneous graft-versus-host disease in an infant with topical pimecrolimus. J Am Acad Dermatol. 2004;50:946–8.

    Article  PubMed  Google Scholar 

  137. Schmook T, Kraft J, Benninghoff B, Nindl I, Roewert J, Ulrich C, et al. Treatment of cutaneous chronic graft-versus-host disease with topical pimecrolimus. Bone Marrow Transplant. 2005;36:87–8.

    Article  PubMed  CAS  Google Scholar 

  138. Mawardi H, Stevenson K, Gokani B, Soiffer R, Treister N. Combined topical dexamethasone/tacrolimus therapy for management of oral chronic GVHD. Bone Marrow Transplant. 2010;45:1062–7.

    Article  PubMed  CAS  Google Scholar 

  139. Penas PF, Fernandez-Herrera J, Garcia-Diez A. Dermatologic treatment of cutaneous graft versus host disease. Am J Clin Dermatol. 2004;5:403–16.

    Article  PubMed  Google Scholar 

  140. Leiter U, Kaskel P, Krahn G, Gottlober P, Bunjes D, Peter RU, et al. Psoralen plus ultraviolet-A-bath photochemotherapy as an adjunct treatment modality in cutaneous chronic graft versus host disease. Photodermatol Photoimmunol Photomed. 2002;18:183–90.

    Article  PubMed  CAS  Google Scholar 

  141. Vogelsang GB, Wolff D, Altomonte V, Farmer E, Morison WL, Corio R, et al. Treatment of chronic graft-versus-host disease with ultraviolet irradiation and psoralen (PUVA). Bone Marrow Transplant. 1996;17:1061–7.

    PubMed  CAS  Google Scholar 

  142. Hearn RM, Kerr AC, Rahim KF, Ferguson J, Dawe RS. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol. 2008;159:931–5.

    Article  PubMed  CAS  Google Scholar 

  143. Brazzelli V, Grasso V, Muzio F, Moggio E, Zecca M, Locatelli F, et al. Narrowband ultraviolet B phototherapy in the treatment of cutaneous graft-versus-host disease in oncohaematological paediatric patients. Br J Dermatol. 2010;162:404–9.

    Article  PubMed  CAS  Google Scholar 

  144. Lee SJ, Flowers ME. Recognizing and managing chronic graft-versus-host disease. Hematology Am Soc Hematol Educ Program 2008:134–41.

    Google Scholar 

  145. Wolff D, Gerbitz A, Ayuk F, Kiani A, Hildebrandt GC, Vogelsang GB, et al. Consensus conference on clinical practice in chronic graft-versus-host disease (GVHD): first-line and topical treatment of chronic GVHD. Biol Blood Marrow Transplant. 2010;16:1611–28.

    Article  PubMed  Google Scholar 

  146. Koc S, Leisenring W, Flowers ME, Anasetti C, Deeg HJ, Nash RA, et al. Therapy for chronic graft-versus-host disease: a randomized trial comparing cyclosporine plus prednisone versus prednisone alone. Blood. 2002;100:48–51.

    Article  PubMed  CAS  Google Scholar 

  147. Sullivan KM, Witherspoon RP, Storb R, Deeg HJ, Dahlberg S, Sanders JE, et al. Alternating-day cyclosporine and prednisone for treatment of high-risk chronic graft-v-host disease. Blood. 1988;72:555–61.

    PubMed  CAS  Google Scholar 

  148. Weng JY, Du X, Geng SX, Peng YW, Wang Z, Lu ZS, et al. Mesenchymal stem cell as salvage treatment for refractory chronic GVHD. Bone Marrow Transplant. 2010;45:1732–40.

    Article  PubMed  CAS  Google Scholar 

  149. Wolff D, Schleuning M, von Harsdorf S, Bacher U, Gerbitz A, Stadler M, et al. Consensus conference on clinical practice in chronic GVHD: second-line treatment of chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2011;17:1–17.

    Article  PubMed  Google Scholar 

  150. Couriel DR, Saliba R, Escalon MP, Hsu Y, Ghosh S, Ippoliti C, et al. Sirolimus in combination with tacrolimus and corticosteroids for the treatment of resistant chronic graft-versus-host disease. Br J Haematol. 2005;130:409–17.

    Article  PubMed  CAS  Google Scholar 

  151. Jedlickova Z, Burlakova I, Bug G, Baurmann H, Schwerdtfeger R, Schleuning M. Therapy of sclerodermatous chronic graft-versus-host disease with mammalian target of rapamycin inhibitors. Biol Blood Marrow Transplant. 2011;17:657–63.

    Article  PubMed  CAS  Google Scholar 

  152. Ponticelli C. De novo thrombotic microangiopathy. An underrated complication of renal transplantation. Clin Nephrol. 2007;67:335–40.

    PubMed  CAS  Google Scholar 

  153. Goussetis E, Varela I, Tsirigotis P. Update on the mechanism of action and on clinical efficacy of extracorporeal photopheresis in the treatment of acute and chronic graft versus host disease in children. Transfus Apher Sci. 2012;46(2):203–9.

    Article  PubMed  Google Scholar 

  154. Gatza E, Rogers CE, Clouthier SG, Lowler KP, Tawara I, Liu C, et al. Extracorporeal photopheresis reverses experimental graft-versus-host disease through regulatory T cells. Blood. 2008;112:1515–21.

    Article  PubMed  CAS  Google Scholar 

  155. Tsirigotis P, Kapsimalli V, Baltadakis I, Kaloyannidis P, Karakasis D, Papalexandri A, et al. Extracorporeal photopheresis in refractory chronic graft-versus-host disease: the influence on peripheral blood T cell subpopulations. A study by the Hellenic Association of Hematology. Transfus Apher Sci. 2012;46(2):181–8.

    Article  PubMed  Google Scholar 

  156. Tsirigotis P, Kaloyannidis P, Papalexandri A, Baltadakis I, Karakasis D, Batsis I, et al. Extracorporeal photopheresis in the treatment of chronic graft-versus-host disease. The Hellenic experience: a study by the Hellenic association of hematology. Transfus Apher Sci. 2012;46(2):173–80.

    Article  PubMed  Google Scholar 

  157. Dignan FL, Greenblatt D, Cox M, Cavenagh J, Oakervee H, Apperley JF, et al. Efficacy of bimonthly extracorporeal photopheresis in refractory chronic mucocutaneous GVHD. Bone Marrow Transplant. 2012;47(6):824–30.

    Article  PubMed  CAS  Google Scholar 

  158. Takami A, Mochizuki K, Okumura H, Ito S, Suga Y, Yamazaki H, et al. Mycophenolate mofetil is effective and well tolerated in the treatment of refractory acute and chronic graft-versus-host disease. Int J Hematol. 2006;83:80–5.

    Article  PubMed  CAS  Google Scholar 

  159. Wang Y, Xu LP, Liu DH, Chen H, Chen YH, Han W, et al. First-line therapy for chronic graft-versus-host disease that includes low-dose methotrexate is associated with a high response rate. Biol Blood Marrow Transplant. 2009;15:505–11.

    Article  PubMed  CAS  Google Scholar 

  160. Inagaki J, Nagatoshi Y, Hatano M, Isomura N, Sakiyama M, Okamura J. Low-dose MTX for the treatment of acute and chronic graft-versus-host disease in children. Bone Marrow Transplant. 2008;41:571–7.

    Article  PubMed  CAS  Google Scholar 

  161. Sullivan KM, Witherspoon RP, Storb R, Weiden P, Flournoy N, Dahlberg S, 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;72:546–54.

    PubMed  CAS  Google Scholar 

  162. Curtis RE, Metayer C, Rizzo JD, Socie G, Sobocinski KA, Flowers ME, et al. Impact of chronic GVHD therapy on the development of squamous-cell cancers after hematopoietic stem-cell transplantation: an international case-control study. Blood. 2005;105:3802–11.

    Article  PubMed  CAS  Google Scholar 

  163. Martin PJ, Storer BE, Rowley SD, Flowers ME, Lee SJ, Carpenter PA, et al. Evaluation of mycophenolate mofetil for initial treatment of chronic graft-versus-host disease. Blood. 2009;113:5074–82.

    PubMed  CAS  Google Scholar 

  164. Furlong T, Martin P, Flowers ME, Carnevale-Schianca F, Yatscoff R, Chauncey T, et al. Therapy with mycophenolate mofetil for refractory acute and chronic GVHD. Bone Marrow Transplant. 2009;44:739–48.

    Article  PubMed  CAS  Google Scholar 

  165. Inamoto Y, Flowers ME. Treatment of chronic graft-versus-host disease in 2011. Curr Opin Hematol. 2011;18:414–20.

    Article  PubMed  CAS  Google Scholar 

  166. Ratanatharathorn V, Ayash L, Reynolds C, Silver S, Reddy P, Becker M, et al. Treatment of chronic graft-versus-host disease with anti-CD20 chimeric monoclonal antibody. Biol Blood Marrow Transplant. 2003;9:505–11.

    Article  PubMed  CAS  Google Scholar 

  167. Kharfan-Dabaja MA, Mhaskar AR, Djulbegovic B, Cutler C, Mohty M, Kumar A. Efficacy of rituximab in the setting of steroid-refractory chronic graft-versus-host disease: a systematic review and meta-analysis. Biol Blood Marrow Transplant. 2009;15:1005–13.

    Article  PubMed  CAS  Google Scholar 

  168. Cutler C, Miklos D, Kim HT, Treister N, Woo SB, Bienfang D, et al. Rituximab for steroid-refractory chronic graft-versus-host disease. Blood. 2006;108:756–62.

    Article  PubMed  CAS  Google Scholar 

  169. Olivieri J, Coluzzi S, Attolico I, Olivieri A. Tirosin kinase inhibitors in chronic graft versus host disease: from bench to bedside. ScientificWorldJournal. 2011;11:1908–31.

    Article  PubMed  CAS  Google Scholar 

  170. Sanchez-Ortega I, Servitje O, Arnan M, Orti G, Peralta T, Manresa F, et al. Dasatinib as salvage therapy for steroid refractory and imatinib resistant or intolerant sclerotic chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2012;18:318–23.

    Article  PubMed  CAS  Google Scholar 

  171. Chen GL, Arai S, Flowers ME, Otani JM, Qiu J, Cheng EC, et al. A phase 1 study of imatinib for corticosteroid-dependent/refractory chronic graft-versus-host disease: response does not correlate with anti-PDGFRA antibodies. Blood. 2011;118:4070–8.

    Article  PubMed  CAS  Google Scholar 

  172. Lazar J, Poonawalla T, Teng JM. A case of sclerodermatous graft-versus-host disease responsive to imatinib therapy. Pediatr Dermatol. 2011;28:172–5.

    Article  PubMed  Google Scholar 

  173. Wang S, Qu X, Zhao RC. Mesenchymal stem cells hold promise for regenerative medicine. Front Med. 2011;5:372–8.

    Article  PubMed  Google Scholar 

  174. Le Blanc K, Rasmusson I, Sundberg B, Gotherstrom C, Hassan M, Uzunel M, et al. Treatment of severe acute graft-versus-host disease with third party haploidentical mesenchymal stem cells. Lancet. 2004;363:1439–41.

    Article  PubMed  Google Scholar 

  175. Ryan JM, Barry FP, Murphy JM, Mahon BP. Mesenchymal stem cells avoid allogeneic rejection. J Inflamm (Lond). 2005;2:8.

    Article  CAS  Google Scholar 

  176. Aggarwal S, Pittenger MF. Human mesenchymal stem cells modulate allogeneic immune cell responses. Blood. 2005;105:1815–22.

    Article  PubMed  CAS  Google Scholar 

  177. Ning H, Yang F, Jiang M, Hu L, Feng K, Zhang J, et al. The correlation between cotransplantation of mesenchymal stem cells and higher recurrence rate in hematologic malignancy patients: outcome of a pilot clinical study. Leukemia. 2008;22:593–9.

    Article  PubMed  CAS  Google Scholar 

  178. Lazarus HM, Koc ON, Devine SM, Curtin P, Maziarz RT, Holland HK, et al. Cotransplantation of HLA-identical sibling culture-expanded mesenchymal stem cells and hematopoietic stem cells in hematologic malignancy patients. Biol Blood Marrow Transplant. 2005;11:389–98.

    Article  PubMed  Google Scholar 

  179. Baron F, Lechanteur C, Willems E, Bruck F, Baudoux E, Seidel L, et al. Cotransplantation of mesenchymal stem cells might prevent death from graft-versus-host disease (GVHD) without abrogating graft-versus-tumor effects after HLA-mismatched allogeneic transplantation following nonmyeloablative conditioning. Biol Blood Marrow Transplant. 2010;16:838–47.

    Article  PubMed  Google Scholar 

  180. Zhou H, Guo M, Bian C, Sun Z, Yang Z, Zeng Y, et al. Efficacy of bone marrow-derived mesenchymal stem cells in the treatment of sclerodermatous chronic graft-versus-host disease: clinical report. Biol Blood Marrow Transplant. 2010;16:403–12.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David Pompei Pharm.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Pompei, D., Russell, K.J., Pereira, F.A. (2013). Graft-Versus-Host Disease. In: Buka, B., Uliasz, A., Krishnamurthy, K. (eds) Buka's Emergencies in Dermatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5031-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5031-3_6

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5030-6

  • Online ISBN: 978-1-4614-5031-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics