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Cause And Symptoms

Complications

Diagnosis And Treatment

Overview

Prevention

References

chronic-graft-versus-host-disease-cgvhd

chronic GRAFT-VERSUS-HOST DISEASE (cGVHD)

<h4>Efficacy and safety of belumosudil as compared with best available therapy for the treatment of chronic graft-versus-host disease in the US population Waller EK (USA)</h4>

<h4>Clinically meaningful improvement of modified Lee symptom scale in patients treated with belumosudil for steroid-refractory chronic GvHD: Evidence from real-world outcomes Kim D (Canada)</h4>

<h4>Efficacy and safety of belumosudil for treatment of cGvHD: multicenter retrospective analysis of the French cohort of the compassionate use program Loschi M (France)</h4>

<h4>Exploring the impact of chronic graft-versus-host disease on the health-related quality of life of patients and caregivers: a qualitative survey-based study in France Kiprijanovski D (France)</h4>

<h4>Impact of belumosudil treatment in advanced chronic graft-versus-host disease (cGvHD): insights into response-based T- and B-cell subpopulation dynamics Ponce D (USA)</h4>

<h4>Description of patients and management of cGvHD in France based on natural language processing (NLP) from medical documents available in hospital electronic medical files Kiprijanovski D (France)</h4>

<h4>Living with GvHD - impact and experience Barata A (USA)</h4>

<h4>Incidence of graft versus host disease according to prophylaxis strategy in matched related and unrelated donor allogeneic hematopoietic stem cell transplantation: realworld experience of GETH-TC Bento L (Spain)</h4>

<h4>Challenges and opportunities of biomarkers in GvHD Greinix HT (Austria)</h4>

<h4>Grade your GvHD yourself - development of an app to document chronic graft-versus-host disease by patients and caregivers Denk A (Germany)</h4>

Abbreviations: 
 ADS, automated data structuration; AE, adverse event; aGvHD, acute graft-versus-host disease; AI-NLP, artificial intelligence natural language processing; allo-HSCT, allogenic hematopoietic stem-cell transplantation; ATG, ati-thymocyte globulin; BAFF, Bcell activating factor; BAT, best available therapy; BID, twice daily; BEL, belumosudil; CD, cluster of differentiation; cGvHD, chronic graft-versus-host disease; CI, confidence interval; CNI, calcineurin inhibitor; CR, complete response; CTLA4; cytotoxic Tlymphocyte associated protein 4; CXCL10, C-X-C motif chemokine ligand 10; DKK3, dickkopf WNT signaling pathway inhibitor 3; ECP, extracorporeal photopheresis; FFS, failure-free survival; GETH-TC, Spanish Group of Hematopoietic Stem Cell Transplantation and Cell Therapy; GI, gastrointestinal; GvHD, graft-versus-host disease; HCT, hematopoietic cell transplantation; HLA, human leukocyte antigen; HrQoL, helath realted quality of life; IL-15, interleukin-15; LOT, lines of therapy; LSS, Lee Symptom Scale; MCS, mental component score; mLSS, modified Lee symptom scale; MMP3, matrix metalloproteinase 3; MS17, mass spectrometry 17; MSD, matched sibling donor; MTX, methotrexate; MUD, matched unrelated donor; NIH, National Institutes of Health; NRM, non-relapse mortality; OPN, osteopontin; ORR, overall response rate; OS, overall survival; PCS, physical component score; PFS, progression-free survival; PR, partial response; PRO, patient-reported outcomes; PTCy, post-transplant cyclophosphamide; PTSD, post-truamatic stress disorder; QOL, quality of life; RCT, randomized controlled trial; REG3α, regenerating islet-derived 3-alpha; RUX, ruxolitinib; RWE, Real-world evidence; sR-cGvHD, steroid-refractory chronic graftversus- host disease; ST2, suppression of tumorigenicity 2; TEM, effector memory T cells; TIM 3, immunoglobulin and mucin domain 3.
 
 &nbsp;

References:

The Congress Connection: cGvHD and Transplant Key Takeaways in 2025

CHRONIC-GRAFT-VERSUS-HOST-DISEASE-CGVHD

TRANSPLANT

Between The Lines: GVHD, Episode 1 – Understanding the Foundation of Graft vs Host Disease

In this first episode of&nbsp;Between The Lines: GVHD, Dr. Francesca Kinsella, Consultant Haematologist at University Hospitals Birmingham and a leading expert in stem cell transplantation, cellular therapy, and GvHD management, is joined by Dr. Inas Al Najar, Consultant, Hematology &amp; Bone Marrow Transplant and Director of Undergraduate &amp; Advanced Programs.
Together, they provide a comprehensive introduction to Graft versus Host Disease (GvHD), discussing its immunological basis, clinical manifestations, and the importance of timely recognition and multidisciplinary care.

Key Insights from the Episode:
<ul>
 <li>GvHD is a complex immune-mediated complication of allogeneic stem cell transplantation.</li>
 <li>The episode outlines key differences between acute and chronic forms, including timing, symptoms, and underlying mechanisms.</li>
 <li>Emphasis is placed on early detection, collaborative care, and emerging strategies for prevention and management.</li>
</ul>

<h4>Development and psychometric validation of a new pediatric chronic GvHD (cGVHD) symptom scale for children and caregiver-proxies Williams K (USA)</h4>

<ul>
 <li>Project 2 is planned to evaluate psychometric testing of scale validity, reliability, and responsiveness (N=120; child-caregiver dyads). Also, determine the lowest age for Lee-scale comprehension by adolescents.</li>
 <li>Current status - recruiting patients.</li>
</ul>

<h4>Chronic GvHD: Nailing the diagnosis &amp; exam Epling P (USA)</h4>

<ul>
 <li>NIH scoring data3: The NIH scoring system for cGvHD includes performance scales (e.g., Karnofsky score), skin involvement (e.g., maculopapular rash, sclerotic features), and organspecific symptoms (e.g., dry eyes, GI symptoms). For example, a performance scale of 80 gives 1 point, skin involvement of 50% BSA gives 2 points, and mild dry eyes not requiring frequent eye drops gives no points.</li>
 <li>Key diagnostic Imaging and physical examination: Diagnostic imaging for GI cGvHD can reveal multifocal small bowel strictures, fluid and gas collections indicating complications like cecal perforation, and mucosal changes in the colon.4 Musculoskeletal symptoms include joint tightness and muscle weakness, often requiring a combination of physical therapy and medical interventions.5</li>
</ul>

<h4>Single center experience of belumosudil in children &lt;12 years, adolescents and young adults Ibrahimova A (USA)</h4>

<ul>
 <li>The ORR was 44%, with PR in 7 patients NR in 9. Among the 2 children &lt;12 years, 1 had a PR and 1 had NR. Organ-specific PRs were observed in skin, mouth, eyes, lungs, genitourinary, joints/fascia, GI tract, and liver. Corticosteroids were successfully weaned in 9 patients. Seven patients discontinued belumosudil due to lack of response, and 1 due to concurrent AEs.</li>
 <li>AEs: Bacterial infections, hepatotoxicity, thrombocytopenia, and QTc prolongation.</li>
</ul>

<h4>Real world outcomes of belumosudil for treatment of chronic graft-versus-host disease: A single center experience Modi B (USA)</h4>

<ul>
 <li>ORR: The best ORR observed was 46.7% (complete response: 6.7% + partial response: 40%) with a median time to best response of 108.5 days. ORR was 31.1% at 6 months and 33.4% at 12 months. Steroid dose reduction and infection rates: About 29% of the patients reduced their corticosteroid dose, and 20% of patients discontinued steroids. Patients on combination therapy with ruxolitinib and belumosudil had higher infection rates (61%) compared to those on belumosudil monotherapy (23%; p=0.01).</li>
 <li>Steroid dose reduction and infection rates: About 29% of the patients reduced their corticosteroid dose, and 20% of patients discontinued steroids. Patients on combination therapy with ruxolitinib and belumosudil had higher infection rates (61%) compared to those on belumosudil monotherapy (23%; p=0.01).</li>
</ul>

<h4>Real-world patient characteristics and treatment patterns in patients with chronic graftversus- host disease receiving belumosudil in the United States Yu J (USA)</h4>

<ul>
 <li>The mean (SD) age was 48.2 (17.4) years, with 56.9% male. Patients started belumosudil a median of 489 days post-cGvHD diagnosis, mainly in LOT 3 or later (81.8%). Prior treatments included ruxolitinib monotherapy (22.5%) and CNI. Belumosudil was used as monotherapy/corticosteroids (45.9%) or combination therapy (54.1%). The median duration of belumosudil LOT was 133 days (IQR; 60–276). By follow-up, 39.8% had discontinued, 27.1% switched, and 20.4% added therapies.</li>
 <li>Belumosudil was largely used after ≥3 prior LOTs, likely due to approval timing. Further research is needed to evaluate treatment sequencing and long-term outcomes.</li>
</ul>

<h4>Patient experiences with chronic graft-versus-host disease and its treatment in the United States: a retrospective social media listening study Cowden MA (USA)</h4>

<ul>
 <li>Treatment regimens for cGvHD are complex and expensive. 10.3% (n=132) of posts mentioned difficulties in accessing new treatments, while 8.3% (n=106) noted the financial burdens associated with care. These challenges underscore the need for better treatment options and support systems.</li>
</ul>

<h4>Harnessing machine learning to predict chronic GvHD: A novel risk stratification score Ramgopal A (Panama)</h4>

<ul>
 <li>With an overall accuracy of 59%, the model shows moderate predictive capability. Enhancing specificity and expanding data could improve accuracy, supporting early risk stratification and optimized HSCT treatment.</li>
</ul>

<h4>Acute and chronic graft versus host disease (GvHD) management in the Eastern Mediterranean region: Result of the Worldwide Network for Blood &amp; Marrow Transplantation (WBMT) global GvHD survey Muhsen IN (USA)</h4>

<ul>
 <li>cGvHD: Systemic steroids were the first-line treatment. For steroid-refractory cases, ruxolitinib (80%) was most used, followed by CNI (67%) and mycophenolate mofetil (53%). Only 20% had multidisciplinary teams, 10% enrolled steroid-refractory patients in trials, and 43% lacked an SOP.</li>
</ul>

<h4>Association of patient-reported outcomes with survival and graft versus host disease in allogeneic hematopoietic cell transplant recipients Ardila V (USA)</h4>

<ul>
 <li>Higher pre-HCT depression and distress were significantly associated with increased aGvHD and trends towards higher incidence cGvHD, NRM, and lower OS.</li>
</ul>

<h4>Impact of graft-versus host disease following allogeneic hematopoietic cell transplantation on leukemia free survival in hematologic malignancies: A CIBMTR Analysis Qayed M (USA)</h4>

<ul>
 <li>The cumulative incidence of relapse for AML was around 20%, with no significant differences in relapse rates based on GvHD grade. In AML patients with low/intermediate or high/very high DRI, no significant differences in cumulative incidence of relapse were found by GvHD severity. In patients with high or very high DRI also, no difference in cumulative incidence of relapse by severity of GvHD was found. However, severe aGvHD was associated with inferior LFS and higher HR for LFS.</li>
</ul>

Abbreviations AE, adverse event; aGvHD, acute graft-versus-host-disease; ALL, acute lymphoblastic leukemia; allo-HCT, allogenic hematopoietic cell transplantation; AML, acute myeloid leukemia; BSA, bovin serum albumin; CIBMTR, Center for International Blood and Marrow Transplant Research; cGvHD, chronic graft-versus-host-disease; CNI, calcineurin inhibitors; DRI, disease relapse index; EM, Eastern Mediterranean; FDA; Food and Drug Administration; GI, gastrointestinal; GvHD; graft-versus-host disease; HCP, healthcare professional; HCT, hematopoietic cell transplant; HR, hazard ratio; HSCT, hematopoietic stem cell transplantation; IQR, interquartile range; LFS, leukemia-free survival; MH, mental health; ML, machine learning; NCCN DT, National Comprehensive Cancer Network Distress Thermometer; NIH, National Institute of Health; NR, no response; NRM, nonrelapse mortality; ORR, overall response rate; OS, overall survival; PCSS, pediatric cGvHD symptom scale; PH, physical health; PHQ-9, Patient Health Questionarie-9; PR, partial response; PRO, patient-reported outcome; PROMIS, Patient-Reported Outcomes Measurement Information System; PTSD, post traumatic stress disorder; QoL, quality of life; Qtc, corrected QT interval; SML, social media listening; SOP, standard operating procedure.

References

Tandem Meetings Transplantation and Cellular Therapy Meetings of ASTCT® and CIBMTR®

<h2>Insights into Bone Marrow Transplants and Understanding cGVHD</h2>
<h3>Bone marrow transplant</h3>

The period after transplant is "vigilant“ as your body is susceptible to multiple infections.2
&nbsp;
Long-term follow-ups are needed for those undergoing bone marrow transplants.2,3

Did you know that... 
 A multi-disciplinary team will take care of you, including pulmonologists, cardiologists, ophthalmologists, and orthopedic doctors.2
What are the essential steps to safeguard your health after bone marrow transplant?3

Use masks and proper hand hygiene for 6 months after transplant and immunosuppression.3,4

Use a separate room and bathroom for 6 months to avoid exposure to infections from visitors.3,5

Avoid contact with people who have fever, cough, flu, and other contagious infections.3

Cook your food thoroughly and avoid unfiltered water.3

cGVHD: Chronic graft-vs.–host disease; GVHD: Graft-vs.-host disease.

<h3>How many bone transplant patients are affected by GVHD?</h3>
Did you know that...Even when the matched donor is a sibling, 1 in 2 bone marrow transplant patients can get affected by acute GVHD, and the occurrence is higher in unmatched donors.6

<h3>Which factors increase the risk of developing cGVHD?</h3>

<h3>What are the basics of cGVHD occurrence?</h3>

cGVHD: Chronic graft-vs.–host disease; GVHD: Graft-vs.-host disease;
<h2>Factors determining the occurrence and severity of GVHD</h2>

&nbsp;
<figure class="table" style="width:552.003px;">
 <table style="background-color:rgb(255, 255, 255);border-bottom-width:1px;border-color:rgb(201, 201, 201);border-left-width:0px;border-right-width:0px;border-style:solid;border-top-width:0px;">
 <tbody>
 <tr>
 <td style="background-color:rgb(115, 190, 131);border-color:rgb(229, 231, 235);border-width:0px;padding:10px;text-align:center;">Increased severity of GVHD6</td>
 </tr>
 </tbody>
 </table>
</figure>

Donor–host factors such as unmatched transplants and specific protein mismatch

High-dose chemotherapy

Full-body radiation

<figure class="table" style="width:552.003px;">
 <table style="background-color:rgb(255, 255, 255);border-bottom-width:1px;border-color:rgb(201, 201, 201);border-left-width:0px;border-right-width:0px;border-style:solid;border-top-width:0px;">
 <tbody>
 <tr>
 <td style="background-color:rgb(101, 147, 192);border-color:rgb(229, 231, 235);border-width:0px;padding:10px;text-align:center;">Reduced severity of GVHD6</td>
 </tr>
 </tbody>
 </table>
</figure>

Use of frozen bone marrow or blood from the umbilical cord

<h3>Did you know the signs and symptoms of cGVHD?11</h3>
It is important to let your doctor know of any of these symptoms immediately. Please refer to the checklist at the back of the booklet for help.

<h3>Precautions to be taken to prevent cGVHD</h3>
cGVHD can be prevented by protecting yourself from acute GVHD. Here are some preventive measures:6

<h2>Enhancing Quality of Life and Wellness</h2>
<h3>Managing cGVHD</h3>
Here are some treatment options available for GVHD.

After the transplant, you will be given preventive (prophylactic) medications to suppress your immune system. This will prevent the donor immune cells from launching an attack against your tissues.6

cGVHD: Chronic graft-vs.–host disease; GVHD: Graft-vs.-host disease.
<h3>GVHD Treatment Strategies: Navigating Acute and Chronic Forms.10</h3>

<figure class="table" style="width:100%;">
 <table class="ck-table-resized">
 <colgroup>
 <col style="width:100%;">
 </colgroup>
 <tbody>
 <tr>
 <td style="background-color:#89d0e8;text-align:center;">The treatment also varies depending on the affected organ. 12,13</td>
 </tr>
 </tbody>
 </table>
</figure>
<figure class="table" style="width:100%;">
 <table class="ck-table-resized">
 <colgroup>
 <col style="width:100%;">
 </colgroup>
 <tbody>
 <tr>
 <td style="background-color:#6593C0;text-align:center;">cGVHD is managed using treatments that suppress the immune system for a long time. Other treatments that your doctor may recommend include ruxolitinib, belumosudil, ibrutinib, and photopheresis.13</td>
 </tr>
 </tbody>
 </table>
</figure>
<figure class="table" style="width:100%;">
 <table class="ck-table-resized">
 <colgroup>
 <col style="width:100%;">
 </colgroup>
 <tbody>
 <tr>
 <td style="background-color:#B2D2BB;text-align:center;">Acute GVHD is treated with increasing doses of medications that suppress your immune system from being too active.</td>
 </tr>
 </tbody>
 </table>
</figure>

<h4>Medications are given:10</h4>
<ul>
 <li>Orally</li>
 <li>Injections</li>
 <li>Creams/lotions</li>
</ul>

<h3>Managing emotional health</h3>

<figure class="table" style="width:100%;">
 <table class="ck-table-resized">
 <colgroup>
 <col style="width:100%;">
 </colgroup>
 <tbody>
 <tr>
 <td style="background-color:#78C68B;text-align:center;">It is important to seek professional support to help deal with the impacts of cGVHD.11</td>
 </tr>
 </tbody>
 </table>
</figure>

Social Workers

Psychiatrists

Psychologists

<figure class="table" style="width:100%;">
 <table class="ck-table-resized">
 <colgroup>
 <col style="width:100%;">
 </colgroup>
 <tbody>
 <tr>
 <td style="text-align:center;">Maintaining a good lifestyle via exercise, yoga, and meditation can help you cope with GVHD.12</td>
 </tr>
 </tbody>
 </table>
</figure>

Increase strength and stamina

Improve the quality of sleep

Reduce fatigue and anxiety

cGVHD: Chronic graft-vs.–host disease; GVHD: Graft-vs.-host disease.
In case of any ADE or side effect from any of treatment regimen please contact SFDA at 19999.

<h2>Thriving With cGVHD: Embracing Care, Adherence, and Support</h2>
You can support your doctor in the long-term monitoring of GVHD by adhering to these tests and check-ups at regular intervals before and after a bone marrow transplant.13

cGVHD: Chronic graft-vs.–host disease; GVHD: Graft-vs.-host disease; MRI: Magnetic Resonance Imaging; TSH: Thyroid Stimulating Hormone; T4: Thyroxine.

<h2>Navigating Everyday Challenges: Living with cGVHD</h2>
<h3>Quick tips for day-to-day life with cGVHD</h3>
While cGVHD can be a long fight, it need not be challenging with the right support.14

Seek counseling and help from your family and friends to help in your recovery.15

Light-intensity exercises will help you overcome physical difficulties and improve your range of movement.15

Creams and lotions prescribed by your doctor will help you overcome skin issues.15

Your doctor and nurse can help you find assistance in managing your finances, work, and childcare issues during the diagnosis.15

<h3>Adherence to medication</h3>

cGVHD: Chronic graft-vs.–host disease.

Bone marrow transplant involves transferring healthy blood cells from a donor to a host. The “graft” from the donor may often attack the “host,” resulting in a condition called GVHD.

cGVHD occurs 100 days after your bone marrow transplant and may affect multiple organs in your body, including your skin, stomach, joints, and nervous system.

Therapies to control your immune system will be given to control cGVHD symptoms.

With the help of your caregiver, you should protect yourself from infections.

You would be advised to seek help as much as possible from your friends, peers, caretakers, and other members of your support system.

Keep a checklist of your symptoms to present to your doctor during check-ups.

Caregivers should assist cGVHD patients in their day-to-day activities. They need to ensure medication adherence and also focus on their own mental and physical well-being.

chronic GRAFT-VERSUS-HOST DISEASE (cGVHD)

Latest Articles

The Congress Connection: cGvHD and Transplant Key Takeaways in 2025

Between The Lines: GVHD, Episode 1 – Understanding the Foundation of Graft vs Host Disease

Tandem Meetings Transplantation and Cellular Therapy Meetings of ASTCT® and CIBMTR®

Latest Resources

Living Beyond cGVHD