[Chronic graft-versus-host disease: diagnosis and treatment]

Chronic graft-versus-host disease (cGVHD) occurs in approximately 40% of patients who undergo allogeneic hematopoietic cell transplantation. It affects various organs and causes significant morbidity and mortality. The manifestations of cGVHD resemble those of autoimmune diseases. Inflammation, cellular immunity, humoral immunity, and fibrosis are implicated in cGVHD pathogenesis. The 2005 NIH consensus criteria for cGVHD have set standards for designing and reporting clinical trials, and the criteria were revised in 2014 to incorporate accumulated evidence and questions. The criteria are ready to be applied to design clinical trials aimed at identifying drugs for the treatment of cGVHD. Recent preclinical cGVHD trials have revealed the central roles of regulatory T cells, Th17 cells, Tc17 cells, follicular helper T cells, and follicular regulatory T cells as well as B cell signaling and fibrosis-promoting factors. Based on these advances, clinical trials targeting the specific pathogenic pathways of cGVHD are rapidly emerging, awaiting the approval of effective drugs to improve patient outcomes.