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Having an Allogeneic Stem Cell Transplant

Graft versus Host Disease (GVHD)

​​​​Graft versus Host Disease (GVHD) is a complication of stem cell transplant (SCT). It happens when the donor stem cells (the graft) try to reject your body (the host). GVHD can be either acute (within 3 months of transplant) or chronic (3 months or later after transplant). Each of these types of GVHD can be mild or severe. Early signs include changes to your skin, stomach/bowel, and liver.

Acute GVHD can happen during the first 100 days after transplant. Since it is important to treat GVHD as soon as possible, you will be watched closely for any early signs of GVHD. You will also have to watch for signs of it even after you are home. Acute GVHD will be treated as soon as the first symptoms appear. It is usually treated with steroids (e.g., prednisone) and/or other drugs (immunosuppressants) that suppress the immune system.

Severe GVHD can be life-threatening. Treating GVHD right away is the best way to control the disease. With time, most GVHD symptoms usually respond to treatment or get better on their own.  Sometimes, even when treated early, GVHD does not go away.

One of the first blood tests you and your donor had done was HLA typing (tissue typing). This was done to find the donor with the closest tissue type to yours. However, there are more differences between you and your donor that tests cannot find. It is these differences that the new donor cells recognize. It is believed that one type of white blood cell that fights infection may see your tissue cells as being different and begin to attack them. Usually, the more difference (mismatch) there is in HLA between you and your donor, the greater the risk there is of GVHD.

Mild GVHD may not always be a disadvantage. In people who have cancer, we know that GVHD, especially chronic GVHD, may have an anti-tumour effect. This means that your new stem cells are looking at your “old” blood cells as foreign and attacking them.

Other than trying to find the best donor for you, you will take medicine to prevent GVHD. These include:

  • anti-thymocyte globulin (given during conditioning)
  • cyclosporine, tacrolimus, or methotrexate (given after the SCT)

Signs of Acute GVHD

Skin:

  • a rash that looks like a sunburn on your hands, feet, and face (often the first sign). The rash may spread to other parts of your body.

Stomach or Bowel:

  • stomach cramping
  • very bad heartburn
  • nausea or vomiting
  • diarrhea: this can be mild or very bad. You could have a few loose bowel movements a day to several watery movements (they may be green and have mucous or blood in them).

Liver:

  • jaundice (the skin and/or whites of your eyes turn yellow)
  • itchy skin
  • nausea and/or vomiting
  • mild tenderness in the upper right stomach

Patients who have acute GVHD are more likely to develop the chronic form later on. Usually, the worse the GVHD, the more symptoms you will have.

  • About 1 out of 5 transplant patients from matched related siblings will have moderate to severe GVHD.
  • About 1 out of 3 transplant patients with unrelated donors will have moderate to severe GVHD.

Chronic GVHD is seen in about half of patients that have donor SCT. It can start months to years after SCT. The cause isn’t known. It is more likely to happen in people that had acute GVHD. Both chronic GVHD and the drugs used to treat it may reduce how well your body fights infection.

If you have chronic GVHD you may have symptoms of acute GVHD. There are other symptoms that can affect you. Chronic GVHD needs to be treated as soon as the first symptoms appear. It is usually treated with meds like prednisone and cyclosporine. Other treatments include:

  • PUVA: This ultraviolet A therapy is used for skin and/or oral GVHD.
  • Photophoresis: This treatment uses ultraviolet light therapy on the blood cells.

Symptoms of Chronic GVHD

Skin:

  • a pink rash on your hands, feet, face, or body that looks like a flush or sunburn
  • a dry, itchy rash that often feels rough
  • a blotchy red rash
  • thickening or lightening of the skin
  • changes in skin colour

Stomach or Bowel:

When the lining of the stomach or bowel is affected, you may have:

  • stomach cramping
  • very bad heartburn
  • nausea or vomiting
  • diarrhea: this can be mild or very bad. You could have a few loose bowel movements a day to several watery movements that may be green and have mucous or blood in them.

Mouth:
When your mouth is affected, you may have:

  • a sore, red, or dry mouth
  • blisters or ulcerations
Eyes
When your eyes are affected, they may be:
  • dry or water a lot
  • sore
  • itchy
  • red
Lungs:
When the lungs are affected, you may:
  • cough
  • wheeze
  • feel short of breath
Back to Complications

Current as of: October 30, 2017

Author: Blood and Marrow Transplant Program, Alberta Health Services