Graft-versus-host disease

  • Definition
    • Graft-versus-host disease (GVHD) is a complication that can occur after certain stem cell or bone marrow transplants.

  • Alternative Names
    • GVHD; Bone marrow transplant - graft-versus-host disease; Stem cell transplant - graft-versus-host disease; Allogeneic transplant - GVHD

  • Causes
    • 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 30% to 40% when the donor and recipient are related
      • Around 60% to 80% when the donor and recipient are not related
  • Symptoms
    • There are 2 types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.

      Acute GVHD usually happens within the first 6 months after a transplant. 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

      Chronic GVHD usually starts more than 3 months after a transplant, and can last a lifetime. Chronic symptoms may include:

      • Dry eyes 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
  • Exams and Tests
    • Several lab and imaging tests can be done to diagnose and monitor problems caused by GVHD.

      A biopsy of the skin, mucous membranes in the mouth, or other parts of the body may help confirm the diagnosis.

  • Treatment
    • After a transplant, the recipient usually takes drugs that suppress 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 of 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.

      Treatment of chronic GVHD includes prednisone (a steroid), or the same drugs that suppress the immune system.

  • Outlook (Prognosis)
    • Outlook depends on the severity of GVHD. People who receive closely matched bone marrow tissue and cells usually do better.

      Some cases of GVHD can damage the liver, lungs, digestive tract, or other body organs. There is also a risk for severe infections.

      Many cases of acute or chronic GVHD can be treated successfully. But this doesn't guarantee that the transplant itself will succeed in treating the original disease.

  • When to Contact a Medical Professional
    • If you have had a bone marrow transplant, call your provider right away if you develop any symptoms of GVHD or other unusual symptoms.

  • References
    • Bashir Q, Champlin R. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 30.

      Majhail NS, Weisdorf DJ. Complications after hematopoietic stem cell transplantation. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 110.