Patients with mild, symptomatic cGVHD limited to a single site may often be managed with local therapies alone, such as topical corticosteroids for skin disease. In contrast, systemic immunosuppressive therapy should be considered when cGVHD involves 3 or more organs or when any single organ has a severity score ≥2. Clinical judgment remains essential, and decisions should be individualized based on high-risk features (eg, thrombocytopenia), the underlying transplant indication (malignant vs nonmalignant disease), and the patient’s overall clinical status.¹

Early initiation of effective systemic therapy in patients with clinically significant disease may help prevent progression to severe cGVHD and reduce transplant-related mortality (TRM). However, the presence of active or comorbid infections may influence both the timing and intensity of systemic treatment. For patients already receiving immunosuppressive therapy, management may include dose escalation of current agents or the addition of new systemic therapies to improve disease control.¹

Because patients with cGVHD—especially those on systemic immunosuppression—are highly immunocompromised, comprehensive infection-prevention measures are a critical component of care.¹