Epidemiology

The number of allogeneic haematopoietic cell transplantations (HCTs) continues to increase.[14]​ Allogeneic HCT from unrelated donors in the US has surpassed the number from related donors.[15]​​

Acute graft-versus-host disease (GVHD)

Incidence ranges from 30% to 50%.[16] However, this varies depending on factors such as donor type (i.e., matched or unmatched; related or unrelated), type of malignant disease, and absent or suboptimal GVHD prophylaxis.[17][18]​​ The incidence is directly related to the degree of human leukocyte antigens (HLA) mismatch.[19]​

The median time to onset of acute GVHD is typically 21-25 days after transplantation. Umbilical cord-blood transplantation has been associated with slower neutrophil recovery with lower incidence and later onset of acute GVHD.[20]

Chronic GVHD

Incidence ranges from 30% in recipients of fully histocompatible transplants to 60% to 70% in recipients of mismatched haematopoietic cells or haematopoietic cells from an unrelated donor.[21]​ Factors that increase the incidence include use of peripheral blood for the transplant and older recipient age.[21] 

Evidence from the US suggests that the median time to diagnosis of chronic GVHD is 4.5 months after HLA-identical sibling transplantation and 4 months after unrelated donor transplantation.[22] De novo chronic GVHD almost never occurs ≥2 years post-allogeneic HCT.

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