Graft Versus Host Disease (GVHD)

What is Graft Versus Host Disease (GVHD)

Graft Versus Host Disease can happen after having a bone marrow transplant or a stem cell transplant. You may develop this condition if you have a type of transplant in which you receive cells that were donated from another person (allogenic cells).

If the donor cells do not recognize your own cells, the donor cells may attack your cells. As the donor cells become part of your body’s disease-fighting system (immune system), the donor cells may also attack normal body tissues.

This most often affects the skin, digestive system, liver, lungs, mucous membranes, and eyes.

GVHD might occur soon after your transplant (acute GVHD), or it might occur months or even years later (chronic GVHD). Symptoms can range from mild to severe.

What are the causes?

GVHD is caused by differences between your body’s cells and the donor cells that you receive. These differences cause the donor cells to attack your body.

What increases the risk?

You have a higher risk for GVHD if:

• A certain protein in some of your blood cells (human leukocyte antigen, or HLA) does not match the donor HLA.
• You or the donor are of advanced age.
• You receive donor cells from someone who is:
  • Not a family member.
  • Not the same sex as you.

There is no way to guarantee that you will not get GVHD from allogenic cells. However, your health care provider will match the donor cells to your cells as closely as possible.

What are the signs or symptoms?

Symptoms of acute GVHD may include:

• Abdominal pain or cramping.
• Loss of appetite.
• Nausea.
• Vomiting.
• Diarrhea. Diarrhea may be watery or bloody.
• Yellowing of the skin and the whites of the eyes (jaundice).
• Dark urine.
• Red, burning rash, especially on the palms, bottoms (soles) of the feet, and the back of the neck.

Chronic GVHD causes the skin and the inside linings of the body to become very dry. Symptoms may include:

• Itchy, thick, scaly skin.
• Red, itchy eyes (conjunctivitis).
• Dry mouth and throat.
• Ulcers inside of the mouth.
• Muscle aches and weakness.
• Joint pain.
• Urinating more frequently than usual.
• Painful urination.
• Vaginal dryness.
• Sexual dysfunction.
• Weight loss.
• Shortness of breath.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms, especially if you recently had a bone marrow or stem cell transplant.
• A physical exam. This may include tests to confirm the diagnosis and check for damage to other parts of your body. Tests may include:
  • A procedure to remove a piece of tissue to be checked under a microscope (biopsy). This may be done by passing a thin, flexible tube through your mouth and down your esophagus into your stomach (endoscopy) or through your anus and into your rectum and colon (colonoscopy).
  • Blood tests.
  • Imaging tests, such as X-rays or CT scans.

How is this treated?

This condition is treated with medicines that reduce the activity of the immune system (immunosuppressive drugs). These medicines block the attacks on your body’s cells and tissues. Medicines that help reduce inflammation (steroids) are most commonly used.

Follow these instructions at home:

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider. You may need to take medicine for a long time. The medicine that you need may also change over time.
• Drink enough fluid to keep your urine clear or pale yellow.
• Immunosuppressive drugs can increase your risk for infections. To protect yourself from infection:
  • Stay up-to-date on your vaccinations. Ask your health care provider what vaccinations you need.
  • Wash your hands often with soap and water. If soap and water are not available, use hand sanitizer.
  • During cold and flu season, avoid crowds.
  • Avoid contact with people who are ill.
• Keep all follow-up visits as told by your health care provider. This is important.

Lifestyle

• Eat a healthy diet.
• Maintain a healthy weight.
• Exercise regularly.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.

Skin care

• Use a skin moisturizer that is recommended by your health care provider.
• Protect your skin from the sun:
  • Avoid being in the sun for long periods of time.
  • Wear protective clothing, a hat, and sunglasses outside.
  • Use a sunscreen with SPF 30 (sun protection factor) or higher.

Contact a health care provider if:

• You have a fever that is between 100.4°F (38°C) and 102°F (38.9°C).
• You vomit.
• You have pain in your abdomen.
• You have diarrhea.
• You have any of the following symptoms that get worse:
  • A rash.
  • Skin dryness.
  • Conjunctivitis.
• You develop jaundice.
• You have blood in your stool.
• You are short of breath.

Get help right away if:

• You have trouble breathing.
• You have chest pain.
• You have a fever that is higher than 102°F (38.9°C).
• You have diarrhea that cannot be stopped (is persistent) and you feel weak, dizzy, or light-headed.