Graft-versus-host disease (GVHD) is a disease that may occur following a stem cell transplant. Stem cell transplants with blood or bone marrow are meant to help replenish your own cell counts. This type of procedure is usually done following cancer treatments. For
The name for this attack is GVHD, and it’s essentially a transplant rejection. There are two types of GVHD: acute and chronic. Both occur in the months after your transplant, but chronic forms of this disease can create long lasting problems.
This article will explain why this happens and what to expect if you develop GVHD.
GVHD is a disease that may occur after you receive an allogeneic stem cell transplantation, or cells that aren’t compatible with your body. This type of transplant is done by taking healthy stem cells from a donor and implanting them into you when your own cells have been destroyed. This type of transplant is often done if you’ve received chemotherapy or radiation to treat blood cancers.
Anytime someone else’s cells or tissue are transplanted into your body, there’s a chance your body will reject the transplant by attacking the new cells. The opposite is the case with GVHD. When GVHD happens, the transplanted cells are the ones attacking your body.
Symptoms can differ slightly between acute and chronic forms of GVHD. They can also differ from one person to the next.
These symptoms, which range in type and severity, can include things such as:
- itchy or painful rash
- large skin blisters
- brittle nails
- dry mouth
- hair loss
- abdominal pain
- ulcers, or sores, in your mouth and other areas of your body that produce mucus
- shortness of breath
- abnormal liver function
- abdominal swelling
- blood clotting problems
- high ammonia levels
- enlarged liver
Additional symptoms affecting your lungs and musculoskeletal system (which includes your bones, cartilage, ligaments, tendons, and connective tissues) often appear in chronic GVHD and can be disabling or even fatal.
Acute vs. chronic GVHD
Treatments for GVHD focus on relieving symptoms and improving your overall quality of life. This is usually done with medications that suppress the immune function of the donated cells. Depending on how severe your symptoms are, you might be given either topical or systemic medications.
Examples of some of the medications used to treat GVHD include:
- corticosteroids, such as methylprednisolone or prednisone
- abatacept (Orencia)
- antithymocyte globulin
- lemtuzumab (Campath)
- cyclophosphamide (Cytoxan)
- methotrexate (Trexall)
- mycophenolate mofetil (CellCept)
- sirolimus (Rapamune)
- tacrolimus (Prograf)
These medications may not work for everyone or forever. For example,
Tips for managing GVHD at home
There may also be things you can do to manage your symptoms without medication at home. It’s important to discuss home management strategies with a doctor or healthcare professional. Some remedies may include:
- using skin moisturizer
- applying sunscreen
- wearing long sleeves and pants to protect your skin
- practicing dental care and oral hygiene, such as regularly brushing your teeth and flossing
- eating a balanced diet
- taking steps to avoid contracting an infection, such as regularly washing your hands
- staying up to date on your vaccinations
You may be at risk of GVHD if you have a suppressed immune system and receive a stem cell transplant. Chemotherapy and radiation can suppress your immune system.
The risk of this disease usually
GVHD may also be more likely to appear if you’ve contracted cytomegalovirus or Epstein-Barr virus.
A doctor will take steps ahead of and directly following your transplant to lower your risk of GVHD. For many people, prophylactic treatment using a combination of cyclosporine and methotrexate may be offered. Other antibacterial, antiviral, and antifungal treatments may also be added to lower your risk of contracting an infection.
A doctor may also be able to lower your risk of the disease by making sure you and your donor are the best possible match for one another. Human leukocyte antigens are usually used to gauge a good match.
It’s important to have a conversation with a doctor ahead of your transplant to fully understand your risks, symptoms to watch for, and steps a doctor may take to lower your risk of GVHD.
If you have certain blood cancers, such as leukemia or lymphoma, and require a transfusion after treatment to replenish your own stem cells, there’s a chance the donation might not agree with your body. Either your cells can reject the donation, or the donated cells may see your body as foreign and launch their own attack. The second condition is a disease called GVHD, and it happens in more than half of everyone who receives a stem cell transplant.
There are measures you can take to try and avoid this disease, but they’re not guaranteed to prevent GVHD. For most people who develop GVHD, the disease resolves within months of their transplant, but it can last a lifetime for other people. Talk with a doctor about the risks and plans to manage them if you’re getting a stem cell transplant.