Learning About Graft-Versus-Host Disease (GVHD)

Graft-versus-host disease (GVHD) may happen after stem cells or other blood-forming cells from a donor (the graft) have been transplanted into your body (the host). The donor's cells include some immune cells. These cells can attack your body.

The transplant may be done to treat leukemia or other forms of cancer. Your bone marrow, which has been damaged by cancer, is first destroyed with high-dose chemotherapy or radiation. Healthy cells from a donor are then put into your body through an intravenous (I.V.) line. Over time, these cells become new, healthy bone marrow.

There are two kinds of stem cell transplants:

• Allogeneic. The cells come from a matched or a partially matched donor. In many cases, this may be a related family member. But stem cells may also come from an unrelated donor who has the same tissue type as you. Unless the donor is your identical twin, the donor's cells won't be a perfect match with yours. This can cause GVHD. It can lead to severe organ damage and death.
• Autologous. The cells come from your own body and are saved. When your own cells are put back into your body, GVHD won't happen.

There are two types of GVHD:

• Acute. This type usually happens within 100 days of a transplant. It involves the skin, gastrointestinal (GI) tract, and liver.
• Chronic. This type usually happens 100 days or more after the transplant. It involves the same body systems as the acute type but also affects the eyes, lungs, genitals, and joints. Chronic GVHD may take years to go away and can even be a lifelong condition.

You may experience either type of GVHD or both of them.

Your immune system includes cells that fight bacteria and viruses. These cells can also tell when they are near cells from a different person's body. They react by attacking those "foreign" cells.

When a donor's cells are transplanted into your body, they see all the cells around them as foreign. This triggers an immune response in the donor cells. The donor cells attack your body. This leads to tissue damage in various organs. And because your bone marrow has been destroyed to prepare for the transplant, your body can't defend itself.

Symptoms of acute GVHD include:

• A rash on the neck, ears, shoulders, palms of the hands, or soles of the feet.
• Diarrhea.
• Nausea.
• Vomiting.
• Stomach and belly pain.

Symptoms of chronic GVHD include the above and also:

• Mouth sores.
• Vision changes.
• Breathing problems.

The doctor can usually diagnose GVHD just by asking about your symptoms and looking at your skin. In some cases, the doctor may do a biopsy of the skin rash, liver, GI tract, or lung. A biopsy is a procedure in which a small sample of the affected tissue is removed and sent to a lab for a closer look.

Treatment of GVHD starts with prevention. When you receive the donor cells, you'll also get medicine that weakens your immune system to prevent rejection. You'll also have medicines to prevent and fight bacterial, viral, and fungal infections. Your doctor will balance the weakening of your immune system against giving the donor cells' a chance to grow healthy bone marrow.

Your treatment will depend on whether you have acute or chronic GVHD and which organs are affected.

Treatment of acute GVHD may include:

• Topical steroids. These creams or ointments are spread on the skin to help control the rash. You may get them over the counter, or your doctor may prescribe them. If you get a prescription steroid, your doctor may tell you to apply it to the rash twice daily and cover the area with a warm, wet towel.
• Skin moisturizers, creams, and antihistamines. These products can help relieve itching.
• Oral steroids. For more severe symptoms, your doctor may prescribe steroids that you take by mouth.
• Other medicine. If your symptoms don't respond to the medicines above, your doctor may prescribe other medicines, including ruxolitinib. This medicine is taken by mouth. It blocks the signals in the donor cells that cause rejection.

Treatment of chronic GVHD may include:

• Topical steroids and skin preparations. As with acute GVHD, these treatments can help ease the skin discomfort caused by the rash.
• Oral glucocorticoids. These are medicines that weaken your immune system to help control rejection. Your doctor may prescribe prednisone. If needed, you may also take ruxolitinib.