Graft Versus Host Disease

What is Graft Versus Host Disease?

Graft Versus Host Disease (GVHD) is when bone marrow or stem cells that come from a donor start to attack the cells of the person who received the transplant. The graft is the donor cells, and the healthy cells in your body are the host. GVHD can happen after you have had an allogeneic transplant. You will receive medication after your transplant to suppress (slow) your immune system and prevent GHVD. In some cases, you may still get GVHD.

GVHD can be mild, moderate, or severe based on your symptoms. GVHD is classified as acute or chronic:

• Acute GVHD starts 10 to 90 days after your transplant and the symptoms often go away after some time. Acute GHVD is staged.
• Chronic GVHD starts about 90 to 600 days after your transplant and can last for many years or your whole life. Chronic GVHD is given a grade.

Ask your provider what type of GVHD you have and what stage or grade it is.

What are the signs and symptoms of GVHD?

You will be watched very closely after your transplant for any signs or symptoms of GVHD. You will have your blood checked to see how your organs are working and your providers will assess your body and ask you questions about your health. Some signs and symptoms they are looking for are:

• A rash on the skin that itches, blisters, and/or peels.
• Abdominal (belly) swelling, diarrhea, nausea, or vomiting.
• A blood test may show your liver is not working as it should.
• Dry, itchy eyes, and blurred vision.
• Dry mouth and painful mouth and throat sores.
• Loss of head and body hair.
• Muscle weakness and joint pain.
• Having trouble breathing.
• Vaginal dryness for women, irritation of the penis and scrotum for men, and painful intercourse for both.

How is GVHD diagnosed?

Tell your provider if you are having any of these symptoms after a transplant so that you can start treatment as soon as possible. Finding GVHD early is important. If your provider thinks you have GVHD, they may do these tests:

• Biopsy.
• Stool sample.
• Blood test: such as complete blood count and liver function test.
• CT scan, MRI, or x-ray.
• Physical and skin exam.

The tests you have are based on the symptoms you are having.

What are the risks of GVHD?

Before an allogeneic transplant, Human Leukocyte Antigen (HLA) Typing is done. HLA typing is a test to make sure the donor’s cells have a makeup similar to yours. Your risk for GVHD is greater if the donor cells are not similar to yours. Your provider may suggest you take immunosuppressive medications to weaken your immune system and prevent the donor cells from attacking your body.

The chemotherapy treatment given before your transplant is meant to destroy your immune system. Your immune system may take some time to recover. It may take even longer if you get GVHD. You will be at a higher risk of infection. Your care team will tell you how to protect yourself from getting infections.

Other risks are:

• Not having had a donor that is related to you.
• As age increases, risk increases.
• Acute GVHD can turn into chronic. Tell your provider about any symptoms you are having.

How is GVHD treated?

GVHD is treated based on whether it is acute or chronic, the symptoms you are having, and which part of your body is affected. In some cases, your dose of medication to suppress your immune system may be increased. Other treatments are:

• Skin-directed therapy may be used if you are having rashes or other issues with your skin. Skin-directed therapy includes the use of topical creams or ointments (placed right on your skin) like corticosteroids. Phototherapy is the use of UV light on the skin for severe skin reactions.
• Medications may be given by mouth or IV (intravenously, into a vein). Most commonly, prednisone and cyclosporine are used.
  • Chemotherapy is the use of anti-cancer medication to kill cancer cells. The type of chemotherapy used for GVHD is cyclophosphamide.
  • Targeted therapy is a type of medication that can help when steroids are no longer working to treat your GVHD. Some of the medications are ibrutinib, ruxolitinib, and belumosudil.
  • Supportive medications can be given to help manage and relieve side effects.
• Clinical trials:  A clinical trial may be part of your treatment plan. To find out more about clinical trials, visit the OncoLink Clinical Trials Matching Service.

Talk to your provider about which treatment is best for you. Do not stop any of your treatments until you talk to your provider. Stopping a treatment without talking with your provider first can make your GVHD worse in some cases.

How should I care for myself?

Take any medications used to prevent or treat GVHD exactly how your provider tells you to. If you are having trouble taking them, talk to your provider or pharmacist. Since GVHD can cause skin issues, it is important to protect your skin by staying out of the sun. If you must go out, wear sunscreen and protective clothing. You should also practice good hygiene such as washing your hands to protect from germs and brushing your teeth. You should avoid crowds and wear a face mask if you are going to be around people.

When should I contact my care team?

Recovery from a transplant can be hard, especially if you get GVHD. Tell your care team if you have any new or worsening symptoms. Let them know if you have a fever or any other signs of infection.

To find out more about health risks after an allogeneic transplant visit OncoLink.org.