Graft-versus-Host Disease (GVHD)

Graft-versus-host disease, or GVHD, is a fairly common side effect of allogeneic blood or marrow transplants. Approximately 50% of patients who undergo a blood or marrow transplant develop it. Some patients with the disease can become very sick, but there are medications that can treat it.

Your physicians at Siteman will work to prevent GVHD. If you develop it, they will have a treatment plan in place.

Graft-versus-host disease is also an active area of research for many Washington University Physicians, and your doctors may be seeking new ways to prevent it and treat it – ways that could potentially benefit you. For instance, our physicians recently discovered that medications called Janus kinase inhibitors are highly effective at both preventing and curing GVHD.

What is graft-versus-host disease?

Graft-versus-host disease occurs when lymphocyte cells from the donor start to attack the body of the patient. Lymphocytes are cells that help the immune system fight disease; they recognize when something foreign is in the body and work to get it out. In the case of transplant patients, however, the donor’s lymphocytes recognize the patient’s body itself as foreign and start to fight it. The cells tend to target the skin, liver, and gastrointestinal system.

There are two types of the condition:

• Acute GVHD: This usually develops within 100 days of the transplant, frequently within three to four weeks. This occurs in one-third to one-half of transplant patients. You are less likely to develop acute GVHD if you are younger and have a well-matched donor.
• Chronic GVHD: This generally arises 100 days or more after the transplant.

What are the symptoms of graft-versus-host disease?

Symptoms include:

• A rash
• Red skin
• Mouth sores
• Diarrhea
• A new onset of nausea and vomiting
• Jaundice, or yellowing of the eyes

How is GVHD treated?

Treatments depend on whether the condition is acute or chronic.

In acute GVHD, doctors work to prevent the disease before it sets in by prescribing a variety of drugs, including methotrexate, cyclosporine, and steroids. These drugs don’t always completely prevent GVHD, but they help ensure that cases remain mild.

Chronic GVHD is treated with drugs that suppress the immune system. You may also be referred to other specialists, such as dermatologists, ophthalmologists, and gastroenterologists, for additional help.

When should I see a doctor?

Your doctors will check you for signs of GVHD at your follow-up appointments after the transplant. Be sure to notify your physicians at Siteman if you develop any new symptoms that could indicate the condition, including a cough, breathing difficulties, fever, diarrhea, new mouth sores or new taste changes, eye irritation and dryness, new skin problems, and nausea and vomiting.