Chronic graft versus host disease: A case series providing diagnostic and therapeutic perspectives

• Author Details:   
• Monika Kumari
• Kingshuk Chatterjee
• Arun Achar
• Adityendu Chakraborty
• Sayoni Ghosh
• Mahormi Mazumder
• Sadia Rifat

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Background: Chronic graft-versus-host disease (cGVHD) is a complex and serious complication that can arise following allogeneic hematopoietic stem cell transplantation (HSCT), leading to significant morbidity. It presents with diverse clinical patterns and can show marked variability depending on the underlying malignancy of the transplant recipient.

This case series aims to provide insight into the clinical characteristics, histopathological findings, and treatment outcomes of patients diagnosed with cGVHD according to the NIH consensus criteria.

Materials and Methods: A retrospective analysis was conducted on five patients with cGVHD who visited from January 2024 to January 2025. Among the patients, two were diagnosed with B-cell acute lymphoblastic leukemia (B-ALL), one patient with large cell lymphoma, another one with acute myeloblastic leukemia presented exhibited lichenoid-type cGVHD, while one patient with B-ALL mixed-type cGVHD. Comprehensive clinical evaluations and histopathological assessments were performed for each patient.

Results: Two patients with B-ALL, one patient with anaplastic large cell lymphoma and another one patient with AML displayed lichenoid-type cGVHD, characterized by symptoms including a pruritic rash and mucosal involvement, confirmed by skin biopsy findings.

One patient with B-ALL demonstrated mixed-type cGVHD, exhibiting features of both lichenoid and vitiligo types.

All patients were started on immunosuppressive drugs, including corticosteroids and additional targeted therapies. By the latest follow-up, three patients showed substantial improvement in their symptoms; however, one patient required continuous modification of their treatment due to persistent cGVHD manifestations. One patient lost to follow up.

Conclusion: This case series illustrates distinct manifestations of cGVHD in patients with different underlying malignancies, underscoring the importance of tailoring treatment strategies. Early recognition and appropriate management are essential for enhancing patient quality of life in those affected by cGVHD.