Jeanne M. Palmer, MD, a hematologist and oncologist in the Department of Hematology and Bone Marrow Transplant Program at Mayo Clinic, discusses the prognosis and challenges of predicting graft-versus-host disease (GVHD) in patients who have undergone transplant.

When looking at types of GVHD, there are acute and chronic disease. With acute GVHD, depending on the conditioning regimen, patient age, prophylaxis, donor, and the degree of human leukocyte antigen matching, prognosis can vary; however, nearly half of patients who receive a transplant will have some form of acute GVHD. The most challenging aspect of diagnosing a patient with GVHD or predicting their risk of developing the disease is that even if the patient has a perfectly matched donor when undergoing a transplant, half will still develop GVHD and half will not.

Unfortunately, there is not a lot that can be done to predict the risk of developing GVHD, Palmer says. Previous research has tried to identify biomarkers that might be predictive of who is going to develop GVHD. From the pre-transplant setting, there is not a lot that can be done to predict for the disease other than examining some of the previously mentioned factors. Most of the risk factors that have been examined to predict GVHD are not controllable either, concludes Palmer.