Graft Versus Host Disease

Graft Versus Host Disease
Graft Versus Host Disease

Overview Of Graft Versus Host Disease

Graft-Versus-Host Disease (GVHD) is a life-threatening complication that can occur after a certain stem cell or bone marrow transplant.

Commonly Associated With

GVHD; Bone marrow transplant – graft-versus-host disease; Stem cell transplant – graft-versus-host disease; Allogeneic transplant – GVHD

Causes Of Graft Versus Host Disease

GVHD may occur after a bone marrow, or stem cell, transplant in which someone receives bone marrow tissue or cells from a donor. This type of transplant is called allogeneic. The new, transplanted cells regard the recipient’s body as foreign. When this happens, the cells attack the recipient’s body.

GVHD does not occur when people receive their own cells. This type of transplant is called autologous.

Before a transplant, tissue and cells from possible donors are checked to see how closely they match the recipient. GVHD is less likely to occur, or symptoms will be milder when the match is close. The chance of GVHD is:

  • Around 35% to 45% when the donor and recipient are related
  • Around 60% to 80% when the donor and recipient are not related

Symptoms Of Graft Versus Host Disease

There are two types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.

Acute GVHD usually happens within days or as late as 6 months after a transplant. The immune system, skin, liver, and intestines are mainly affected.

Common acute symptoms include:

  • Abdominal pain or cramps, nausea, vomiting, and diarrhea
  • Jaundice (yellow coloring of the skin or eyes) or other liver problems
  • Skin rash, itching, redness on areas of the skin
  • Increased risk for infections

Chronic GVHD usually starts more than 3 months after a transplant and can last a lifetime.

Chronic symptoms may include:

  • Dry eyes, burning sensation, or vision changes
  • Dry mouth, white patches inside the mouth, and sensitivity to spicy foods
  • Fatigue, muscle weakness, and chronic pain
  • Joint pain or stiffness
  • Skin rash with raised, discolored areas, as well as skin tightening or thickening
  • Shortness of breath due to lung damage
  • Vaginal dryness
  • Weight loss
  • Reduced bile flow from the liver
  • Brittle hair and premature graying
  • Damage to sweat glands
  • Cytopenia (decrease in the number of mature blood cells)
  • Pericarditis (swelling in the membrane surrounding the heart; causes chest pain)

Exams & Tests

Several labs and imaging tests can be done to diagnose and monitor problems caused by GVHD.

These may include:

  • X-ray abdomen
  • CT scan abdomen and CT chest
  • Liver function tests
  • PET scan
  • MRI
  • Capsule endoscopy
  • Liver biopsy
  • A biopsy of the skin, mucous membranes in the mouth, may also help to confirm the diagnosis.

Treatment Of Graft Versus Host Disease

After a transplant, the recipient usually takes medicines, such as prednisone (a steroid), which suppresses the immune system. This helps reduce the chances (or severity) of GVHD.

You’ll continue taking the medicines until your health care provider thinks the risk for GVHD is low. Many of these medicines have side effects, including kidney and liver damage. You’ll have regular tests to watch for these problems.