Clinical update on graft-versus-host disease in children

The last decade has yielded many significant advances in hematopoietic transplantation techniques, immunomodulatory prophylaxis, and diagnostic and treatment approaches to acute and chronic graft-versus-host disease (GVHD). Unfortunately, GVHD remains the cardinal complication in allogeneic hematopoietic stem cell transplantation, with significant associated rates of morbidity and mortality. In this review, we highlight the numerous strides that have been made in making hematopoietic transplantation more successful and provide an update on the clinical and histopathological features of both acute and chronic GVHD in the pediatric population. It is critical for dermatologists to be aware of the characteristic features of cutaneous acute and chronic GVHD and to remain up to date on the evolving spectrum of these conditions. We discuss 5 cases with clinico-pathologic correlation to illustrate the key concepts and principles underlying the diagnosis and management of both acute and chronic GVHD.