ADVANCES IN HEMATOPOIETIC CELL TRANSPLANTATION Current issues in chronic graft-versus-host disease

Chronic graft-versus-host disease (GVHD) is currently the leading cause of long-term morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT). Although early transplantation-related mortality after allogeneic HSCT has decreased through the introduction of reduced-intensity conditioning (RIC) regimens and more effective anti-infectious agents, little progress has been made in decreasing late transplantation-related mortality. This lack of success is mainly the result of our failure to reduce the incidence and severity of chronic GVHD. However, recent progress has been made in two directions. First, human studies and the development of new murine models have led to a much better understanding of the complex pathophysiology of chronic GVHD. Second, the National Institutes of Health (NIH) consensus conference on chronic GVHD that was held in 2005 has led to a better understanding of the wide spectrum of disease manifestations, a new clinical severity index to monitor disease progression and response to therapy, and the assessment of new therapies using innovative clinical trial designs. This review concentrates primarily on recent advances and current issues in human chronic GVHD. Readers are referred to previous reviews as well as an excellent textbook edited by Vogelsang and Pavletik that also provides a detailed analyses of the literature until 2009.