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Haemopoietic-cell transplantation (HCT) is an intensive therapy used to treat high-risk
haematological malignant disorders and other life-threatening haematological and genetic
diseases. The main complication of HCT is graft-versus-host disease (GVHD), an immunological
disorder that affects many organ systems, including the gastrointestinal tract, liver,
skin, and lungs. The number of patients with this complication continues to grow,
and many return home from transplant centres after HCT requiring continued treatment
with immunosuppressive drugs that increases their risks for serious infections and
other complications. In this Seminar, we review our understanding of the risk factors
and causes of GHVD, the cellular and cytokine networks implicated in its pathophysiology,
and current strategies to prevent and treat the disease. We also summarise supportive-care
measures that are essential for management of this medically fragile population.