Management of Graft-versus-Host Disease

Acute GVHD Management

The National Comprehensive Cancer Network recommends systemic corticosteroids as the cornerstone of first-line therapy for both acute and chronic GVHD, with treatment intensity stratified by disease grade and organ involvement 1, 2
For Grade I acute GVHD, the National Comprehensive Cancer Network suggests continuing or restarting the original immunosuppressive agent, applying medium- to high-potency topical steroids, and adding antihistamines for symptomatic pruritus relief 1, 3
For Grades II-IV acute GVHD, the National Comprehensive Cancer Network recommends methylprednisolone 0.5-1 mg/kg/day for Grade II disease and 1-2 mg/kg/day for Grade III-IV disease, with a maximum dose of 2 mg/kg/day 1, 3
The National Comprehensive Cancer Network defines response as complete resolution or improvement in ≥1 organ without progression in others, and recommends tapering steroids as clinically feasible once response is achieved 1, 3

The National Comprehensive Cancer Network recommends systemic corticosteroids 0.5-1 mg/kg/day combined with continuation or escalation of the original calcineurin inhibitor as first-line therapy for chronic GVHD 2, 6
For organ-specific topical therapies, the National Comprehensive Cancer Network suggests triamcinolone, clobetasol, or topical tacrolimus for skin, dexamethasone oral rinse for oral cavity, and topical estrogen for vulvovaginal involvement 2, 6, 4
The National Comprehensive Cancer Network recommends ibrutinib as the only FDA-approved second-line therapy for steroid-refractory chronic GVHD 2, 6, 4

The National Comprehensive Cancer Network recommends tapering steroids according to NIH Response Criteria once improvement is documented, with a slow taper essential to prevent GVHD flares while minimizing long-term steroid complications 2, 6, 4
The National Comprehensive Cancer Network suggests multidisciplinary care to prevent irreversible organ damage and preserve function, with organ-specific supportive interventions integrated throughout treatment 2, 5, 4