In this issue of Blood, Flowers and colleagues report on the risk factors for acute and for chronic graft-versus-host disease (GVMD) in a sizable cohort of 2941 first allogeneic transplantation recipients. Many factors were similar; some were not shared. In risk factors associated with chronic GVHD, point estimates and confidence intervals were not significantly changed after adjustment for prior acute GVHD. These results strongly support the concept that chronic GVHD is not simply the end stage of acute GVHD.Chronic GVHD has remained an elusive disorder to characterize. Many patients with a history of acute GVHD later develop chronic GVHD. If acute GVHD is totally prevented by rigorous T-cell depletion of the donor graft, the risk of chronic GVHD is reduced to essentially zero. These observations led to the supposition that acute GVHD and chronic GVHD were the same disorder, with distinctive manifestations at different times after transplantation.
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