Table 2.

Pathophysiology, risk factors, and clinical presentation of acute and chronic GVHD.

GVHD type	Pathophysiology pathways8,9,11	Risk factors12	Clinical presentation
Acute GVHD	• Tissue damage from conditioning or infection • Recognition of foreign major and minor HLA antigens • Altered mechanisms of tissue repair and protection	• Degree of HLA mismatch • Female donors to male recipient • Total body irradiation	• Skin: maculopapular rash • Gastrointestinal Tract: nausea, vomiting, diarrhea • Liver: hyperbilirubinemia and jaundice
Chronic GVHD	• Acute inflammation and tissue injury • Chronic inflammation and dysregulated T-cell and B-cell immunity • Aberrant tissue repair and fibrosis	• Degree of HLA mismatch • Older patient age • Older donor age • Female donors to male recipient • Mobilized peripheral blood cell graft • Prior history of acute GVHD	Can present with inflammatoryand/or fibrotic manifestations in the following organs: • Skin • Mouth • Eyes • Gastrointestinal Tract • Liver • Lungs • Joint/Fascia • Genital Tract

Abbreviations: GVHD, graft versus host disease; HLA, human leukocyte antigen.