Graft vs. Host Disease (GVHD)

What is Graft vs Host Disease or GVHD?

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 unrelated donor: A donor that is not a sibling or other familial relation of the patient (recipient).
• Patients transplanted with stem cells stem cells: Cells in the body that develop into other cells. There are two main sources of stem cells. Embryonic stem cells come from human embryos and are used in medical research. Adult stem cells in the body repair and maintain the organ or tissue in which they are found. Blood-forming (hemapoietic) stem… gathered from peripheral blood, rather than bone marrow bone marrow: The soft, spongy tissue inside most bones. Blood cells are formed in the 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 aplastic anemia: (ay-PLASS-tik uh-NEE_mee-uh) A rare and serious condition in which the bone marrow fails to make enough blood cells - red blood cells, white blood cells, and platelets. The term aplastic is a Greek word meaning not to form. Anemia is a condition that happens when red blood cell count is low. Most… , MDS, or PNH.

What causes GVHD?

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

What are the symptoms of GVHD?

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

How do you diagnose GVHD?

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.

How do you treat GVHD?

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 cyclosporine: Cyclosporine is used along with antithymocyte globulin (ATG), another immunosuppressant, for treating aplastic anemia and some other forms of bone marrow failure. or mycophenolate mofetil mycophenolate mofetil: Mycophenolate mofetil is approved by the U.S. Food and Drug Administration (FDA) to prevent organ rejection in people who have received a kidney, heart, or liver transplant. This medicine comes as a capsule, tablet, or liquid that is taken by mouth. Researchers are currently studying MMF in… or tacrolimus tacrolimus: Tacrolimus is in a class of medications called immunosuppressants. It works by decreasing the activity of the immune system. Tacrolimus can be prescribed to treat and prevent graft vs host disease (GVHD). It can also be used as part of combination therapy to treat aplastic anemia in place of… or methotrexate.

Clinical trials Clinical trials: Clinical research is at the heart of all medical advances, identifying new ways to prevent, detect or treat disease. If you have a bone marrow failure disease, you may want to consider taking part in a clinical trial, also called a research study. Understanding Clinical Trials Clinical… , 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.