Chronic graft versus host disease Volume 16, issue 6, novembre-décembre 2010

Service d'hématologie-greffe, Hôpital Saint-Louis, Paris

Chronic graft versus host disease (cGvH) is the leading cause of long term non relapse mortality after hematopoietic stem cell transplant (SCT). The national institutes of health (NIH) proposed recently new criteria for the diagnosis, classification and stratification of patients with cGVH after allo-SCT. The diagnosis is still based on physical examination but with no limitations regarding the classical timing suggested by the Seattle group (acute GvH before day 100 and cGvH after day 100). This new classification is supposed to better describe the extension as well as the severity and functional status of patients diagnosed with cGVHD. Steroids and cyclosporine or tacrolimus remain the standard as initial therapy. This combination is effective in the majority of affected patients, although immunosuppressive therapy is often required for more than 1 year. Second line treatments are also described.