Prognosis

Prognosis is a term used to describe an informed prediction of the likely outcome of a medical condition. While graft-versus-host disease (GvHD) can often be successfully managed, it can, in some cases, be life-threatening. The prognosis, or outlook, for patients with GvHD can vary depending on several factors, such as:

• The severity of GvHD
• How well the patient responds to initial treatment
• If the patient has extensive skin GvHD, diarrhea, low levels of platelets in their blood, affected lungs, or an affected liver that may not be functioning properly

Healthcare professionals will consider these factors, along with the patient's overall health, to determine the patient's prognosis and how they predict the condition might improve or progress over time.

Response to treatment

Treatment response refers to how the patient's condition changes following therapy. Once treatment begins, patients are closely monitored for any changes in symptoms and overall health to evaluate how well the treatment is working. Healthcare professionals use specific criteria for each organ affected by GvHD to determine how a patient has responded to treatment:

• Complete response
  • All signs and symptoms of GvHD in each affected organ have completely resolved
• Partial response
  • Improvement of signs and symptoms in at least one affected organ without any worsening in any other area
• Progression
  • Worsening of signs and symptoms in any affected organ
• Mixed response
  • Improvement in at least one affected organ (complete response or partial response) with worsening in a different organ
• Unchanged/no response
  • Unchanged/no response

If the symptoms begin to stabilize and improve, the treatment may be gradually reduced over time, and eventually may be discontinued. If the condition does not respond to therapy, other treatment options may be explored.

References

1. Graft vs. host disease. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10255-graft-vs-host-disease-an-overview-in-bone-marrow-transplant. Accessed Dec 16, 2024.
2. Justiz Vaillant AA, Modi P, Mohammadi O. Graft-versus-host disease. In: StatPearls. StatPearls Publishing; 2024. http://www.ncbi.nlm.nih.gov/books/NBK538235/. Accessed Dec 16, 2024.
3. Lee SJ, Wolff D, Kitko C, et al. Measuring therapeutic response in chronic graft-versus-host disease. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: IV. The 2014 Response Criteria Working Group report. Biol Blood Marrow Transplant. 2015;21(6):984-999. DOI: 10.1016/j.bbmt.2015.02.025.
4. Levine JE, Logan B, Wu J, et al. Graft-versus-host disease treatment: predictors of survival. Biol Blood Marrow Transplant. 2010;16(12):1693-1699. DOI: 10.1016/j.bbmt.2010.05.019.
5. Graft-versus-host disease. Leukemia & Lymphoma Society. https://www.lls.org/treatment/types-treatment/stem-cell-transplantation/graft-versus-host-disease. Accessed Jan 9, 2025.
6. Zeiser R, Blazar BR. Acute graft-versus-host disease - Biologic process, prevention, and therapy. N Engl J Med. 2017;377(22):2167-2179. DOI: 10.1056/NEJMra1609337.