Bone marrow transplantation has changed remarkably from its earliest days. Patients were transplanted with bone marrow as a last resort for refractory leukemia or aplastic anemia. The transplant procedure required prolonged hospital stays – often months - with significant uncontrolled toxicities from the preparative regimen, limited antimicrobial success, and even more limited ability to prevent or treat acute graft versus host disease (GVHD). The lucky survivors now marvel at how different the experience is for patients receiving allografts as outpatients.

Unfortunately, the same level of improvement has not been seen in chronic GVHD. The reasons for this lack of success are varied – including the latency of chronic GVHD, lack of accepted readily reproducible animal models, and complex underlying immuno-pathology. It is no wonder that patients with this affliction felt like abandoned stepchildren.

Over the last 5 years, there has been both a resurgence of interest and progress in chronic GVHD. To a significant degree, the NIH-sponsored Consensus Conference on Chronic GVHD is responsible for this change. This conference suggested working definitions, standardized staging and response criteria, recommended supportive care measures, and suggested areas for future study. Although the indolent nature of the disease means that clinical progress is going to be time consuming, there has been remarkable progress since the initial NIH-sponsored meeting. One of the main lessons learned is that it is imperative to have transplant centers cooperate in studying this disorder.