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Published online by Cambridge University Press: 05 November 2013
In the past, chronicgraft-versus-host disease (cGVHD) was characterized by time of onset.Generally speaking, any manifestation of GVHD after day 100 was termed cGVHD. The NIH Consensus Working Group data suggest thatclinical manifestations, and not the time to symptomatic onset aftertransplantation, determine whether the syndrome is acute or chronic. Inaddition, a new scoring/grading system replaces the historical system ofclassifying a patient as having “limited” or “extensive” disease.
There is no consensusregarding the pathogenesis of cGVHD. T lymphocytes play a major role butevidence shows that in some patients there is coordinated B-cell and T-cellattack. In addition, some data suggest that cGVHD may be related toautoimmune reactions of the donor cells.
Risk factors
Accepted factors
history of grade II or higher acute GVHD (aGVHD);
disparity at class I or class II human leucocyte antigen (HLA) loci;
peripheral blood stem cells versus bone marrow source;
patient diagnosis (chronic myelogenous leukemia [CML] and aplastic anemia);
female donor ͢ male recipient (even greater if parous);
older recipient age;
multiparous female donor;
history of acute inl ammation (e.g., TEN, Stevens Johnson, and others);
non-T-cell-depleted source;
donor lymphocyte infusion (DLI);
sun exposure.
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