Graft vs. Host Disease (GVHD) | Aplastic Anemia and MDS International Foundation

Graft vs. Host Disease (GVHD)

Graft versus host disease (GVHD) is a common complication of a stem cell/bone marrow transplant. It happens when the donor's immune cells, now in the patient, begin to see the patient's body as foreign, triggering an immune response to attack.

Graft vs. Host Disease (GVHD)

The Basics

There are two types of GVHD that can range from mild to life-threatening:

  • Acute GVHD most commonly occurs within the first 100 days after transplant and, while it can affect any part of the body, it typically affects the patient’s skin, liver, stomach and intestines.
  • Chronic GVHD happens more than 100 days after transplant and can reoccur for several years. While it can still affect the same organs as acute GVHD, chronic GVHD more commonly affects the joints, eyes, mouth, lungs and skin.

The chance of getting GVHD varies a lot from patient to patient. Studies show that between 2 and 6 out of every 10 patients transplanted with donor cells will develop some level of GVHD after transplant. The chance of getting GVHD is higher in:

  • Older patients
  • Patients who were transplanted with cells from an unrelated donor
  • Patients transplanted with stem cells gathered from peripheral blood, rather than bone marrow or cord blood

Most cases of GVHD are mild or moderate and resolve over time. However, GVHD can be more severe and life threatening in some cases.

Relation to bone marrow failure diseases:

GVHD can result from having a stem cell transplant (also called a bone marrow or peripheral blood or umbilical cord transplant) to cure the aplastic anemia, MDS, or PNH.

Causes

GVHD can be caused by receiving a stem cell transplant from a donor.

Symptoms

GVHD signs and symptoms include, but are not limited to:

  • Red rash and itching
  • Yellow tint to the skin or whites of the eyes (jaundice caused by liver failure)
  • Skin changes, including darkening or tightening of the skin
  • Abdominal pain
  • Diarrhea (large volumes, liquid and frequent)
  • Nausea and vomiting
  • Joint or muscle pain
  • Shortness of breath
  • Persistent cough
  • Vision changes, such as dry eyes
  • Dry mouth
  • Mouth sores
  • Vaginal dryness

Diagnosis

A physical exam and several lab and imaging tests can be done to diagnose and monitor problems caused by GVHD.
A biopsy of the skin, mucus membranes in the mouth, or other parts of the body may help confirm the diagnosis.

Treatment

After a transplant, the recipient usually takes immune suppressants to reduce the risk of developing GVHD. Patients stay on this medicine until their doctor thinks the risk of GVHD is low. A typical regimen includes the use of cyclosporine or mycophenolate mofetil or tacrolimus or methotrexate.
Clinical trials, also called research studies may offer good treatment options for some people GVHD. These studies also help researchers better understand the value of promising new treatments or procedures.