Graft-Versus-Host Disease

Graft-versus-host disease (GVHD) is a condition that may occur after a person receives bone marrow cells or stem cells, from another donor, known as an allogeneic transplant. Graft-versus-host disease is most commonly associated with bone marrow/stem cell transplant, but may also be found with other forms of tissue/organ transplant. In GVHD, donor cells view the recipient’s healthy cells as a foreign entity and attack the body as a result. The two types of graft-versus-host disease are acute and chronic. The acute form usually shows within the first 100 days after a transplant, whereas chronic GVHD typically appears later. There also exists an overlap between acute and chronic that demonstrates that the time since transplant is not the only factor involved in its genesis.

Graft-versus-host disease manifestations may occur in multiple organs but will most commonly affect the liver, skin, or gastrointestinal system. Complications can range from mild to life-threatening and depend on whether GVHD is acute or chronic. Graft-versus-host disease will not occur when people receive their own bone marrow or stem cells, also known as an autologous transplant.

Signs and symptoms of acute GVHD may include one or more of the following:

  • Abdominal pain
  • Diarrhea
  • Itching
  • Jaundice or other liver problems
  • Nausea and vomiting
  • Skin rash or redness

Signs and symptoms of chronic GVHD may include one or more of the following:

  • Changes to appearance of skin
  • Chronic pain
  • Dry eyes or mouth
  • Fatigue
  • Joint pain or stiffness
  • Shortness of breath
  • Vaginal dryness
  • Vision changes
  • Unexplained weight loss

Prognosis depends on the type and stage of GVHD. Suggested risk factors for graft-versus-host disease may include older age, the recipient being the opposite gender of the donor, an abundance of T-cells in donated material, and a donor who carries certain viruses. People who receive a closer match in bone marrow tissue and cells usually respond better to treatments.

Graft-versus-host disease often disappears within a year or two of a transplant, therefore the physician may suggest active surveillance prior to treatment. Treatment options may also include a combination of steroids, medications that suppress the immune system, new targeted agents and antibiotics to fight infections.