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Learn MoreGraft versus host disease (GVHD) is a serious, sometimes life-threatening complication of a hematopoietic cell transplant (commonly known as bone marrow transplant or stem cell transplant).
GVHD can happen after an allogeneic transplant. There are 2 kinds of transplants based on the source of the hematopoietic (blood-forming) cells – allogeneic and autologous. An allogeneic transplant occurs when the cells come from another person. An autologous transplant occurs when the cells come from the patient.
GVHD occurs when immune cells from the donor (the graft) recognize the patient’s normal cells and tissues (the host) as foreign and attack them. The immune reaction symptoms depend on which part of the body is damaged by the donor cells.
GVHD occurs in approximately 20-50% of patients after transplant. It can develop at any time after transplant. Once it occurs, GVHD can be difficult to treat and in severe cases can be life-threatening.
GVHD has 2 types:
Acute GVHD is commonly defined as disease that occurs during the first 100 days after transplant. But it can occur at any time. Signs and symptoms typically involve the skin, gastrointestinal (GI) tract, and liver. The donor immune cells involved are primarily T cells.
Signs and symptoms may be mild to severe. They may include:
Skin
GI tract
Liver
Chronic GVHD is commonly defined as disease that occurs more than 100 days after transplant. But it can appear earlier. It is similar to an autoimmune disease and can affect multiple organs or organ systems. The donor immune response involves primarily T cells and B cells.
Signs and symptoms may be mild to severe. They may include:
Risk factors for GVHD include:
The care team will take steps to help prevent GVHD.
Patients and families are encouraged to take an active role in helping to prevent GVHD:
Patients will be monitored very closely for signs of GVHD. This process may include physical exams, taking of medical history, lab tests, and imaging tests.
Further testing depends of types of symptoms. Tests could include obtaining a tissue sample through a biopsy, including skin, upper endoscopy and/or colonoscopy, lab tests, and imaging tests.
Treatment is aimed at stopping the overactive donor immune response and retraining the immune system to not attack the normal host tissues. Treatment may vary between patients based on their symptoms.
Corticosteroids such as methylprednisolone, dexamethasone and prednisone are a mainstay of treatment for GVHD. Medications may be given by vein, mouth, cream or ointment, eye drops or oral rinse.
Other medicines may include immunosuppressive medications (such as those listed above in Prevention section), immunotherapy and targeted therapy.
Narrowband ultraviolet (UV) B phototherapy and extracorporeal photopheresis (ECP) are 2 therapies that both use light to treat GVHD.
UV phototherapy uses UVB radiation to heal skin problems caused by GVHD.
ECP involves collecting blood and separating it into red blood cells, white blood cells, and platelets. The white blood cells are treated with drugs and exposed to ultraviolet (UV) light. Then these cells, along with the other blood cells, are returned to the body. The treated cells may stimulate the immune system to help fight GVHD.
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Note: A common misconception is that GVHD is necessary for a transplant to be successful. This is not true. A patient does not have to develop GVHD for the transplant to be successful.
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Reviewed: January 2019