Inpatient Management of Mucocutaneous GVHD

  • Toral S. Vaidya
  • Christian Menzer
  • Doris M. Ponce
  • Alina MarkovaEmail author
Hospital-Based Dermatology (L Guggina and A Zhou, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Hospital-based Dermatology


Purpose of Review

Graft-versus-host disease (GVHD) is an immune mediated disorder affecting 30–70% of patients after allogeneic hematopoietic stem cell transplantation (alloHSCT), and is a major cause of morbidity and non-relapse mortality (NRM) as reported by Jagasia, et al. (Blood 119:296-307, •2012). Dermatologists play a critical role in acute and chronic GVHD, as skin involvement is common and often the earliest involved site of disease as reported by MacMillan, et al. (Biol Blood Marrow Transplant 21: 761-7, 2015).

Recent Findings

GVHD shares clinical and histopathological features with a variety of other skin diseases, requiring thorough consideration of differential diagnoses in hematopoietic stem cell transplantation (HSCT) recipients with lesions suggestive of cutaneous GVHD. Treatment considerations for GVHD are influenced by factors such as disease classification, overall grading, organ involvement, associated symptoms, and immunological anti-tumor effect. Several treatments are available and may be indicated as monotherapy or adjuvant therapy to allow faster withdrawal or tapering of immunosuppression. While corticosteroids are often first-line therapy, oral ruxolitinib has been recently approved for treatment of steroid-refractory acute GVHD (aGVHD), and oral ibrutinib has been approved for steroid-refractory chronic GVHD (cGVHD).


This article provides current clinical, diagnostic, and therapeutic considerations relevant to the hospitalist for both acute and chronic mucocutaneous GVHD. Optimal inpatient management of these diseases requires an interdisciplinary team.


Graft versus host disease Acute graft versus host disease Chronic graft versus host disease Inpatient management GVHD Dermatology hospitalist Inpatient dermatology 


Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Toral S. Vaidya
    • 1
  • Christian Menzer
    • 1
  • Doris M. Ponce
    • 2
    • 3
  • Alina Markova
    • 1
    • 4
    Email author
  1. 1.Dermatology Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Adult Bone Marrow Transplantation Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of DermatologyWeill Cornell Medical CollegeNew YorkUSA

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