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Chronic graft versus host disease (cGVHD) is an alloreactive phenomenon that often complicates allogeneic stem cell transplantation (SCT). Significant progress has been made in acute graft versus host disease (aGVHD) prophylaxis and management. Similar progress in cGVHD has been elusive due to multiple factors, including lack of well defined and prognostically validated classification. This in turn leads to enrollment of a heterogeneous spectrum of cGVHD patients on clinical trials and confounds accurate interpretation of the outcome. Lack of appropriate animal models and the true pathogenesis of this clinical entity with protean manifestations have limited the progress in this field.
The spectrum of allogeneic SCT has increased to include elderly patients and alternative stem cell sources. Advances in critical care, better understanding of infectious disease post SCT and the advent of reduced-intensity and nonmyeloablative conditioning regimens has decreased early mortality after SCT. Thus, the combination of these factors, over time, has lead to an increasing number of patients post SCT at risk for developing cGVHD. Thus it is important to revisit and reaccess cGVHD in the current milleau of SCT.
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