Treatment Side Effects - Graft-Versus-Host Disease (GVHD)

Graft-versus-host disease (GVHD) is a potential complication from stem cell transplants, also known as bone marrow transplants. During a stem cell transplant, a person is given high doses of chemotherapy, which kills off cancer cells as well as the healthy stem cells that create new blood cells. Then, the patient receives a donor's stem cells (the graft), which develop into the new healthy blood cells. In GVHD, the grafted cells begin to attack the patient's body (the host).^1,2

Symptoms of graft-versus-host disease

GVHD may be acute or chronic. Acute GVHD usually occurs within the first 6 months after the transplant, and common symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain or cramps
• Yellow skin or eyes (jaundice)
• Skin rash, itching or redness
• Dryness or irritation of the eyes^1,3

Chronic GVHD usually occurs more than 3 months after the transplant, and it may continue throughout a person's life. Common symptoms of chronic GVHD include:

• Changes to vision
• Dry eyes
• Dry mouth or white patches inside the mouth
• Difficulty swallowing
• Sensitivity to spicy foods
• Fatigue
• Muscle weakness
• Chronic pain
• Joint pain or stiffness
• Skin rash with raised, discolored areas
• Skin thickening or tightening
• Shortness of breath
• Vaginal dryness
• Penile dysfunction
• Increased frequency of urinating, burning or bleeding with urination
• Weight loss^1,3

Both acute and chronic GVHD can range from mild to severe. Any signs or symptoms of GVHD should be immediately brought to the attention of a healthcare professional.

Reducing the risk of graft-versus-host disease

To reduce the risk of GVHD, doctors try to match the proteins on the surface of the cells, called human leukocyte antigen (HLA), between recipient and donor. These are usually the most common between related people, and many stem cell donors are related to the patient. The more similar the HLA proteins are, the lower the risk of GVHD. However, it still can occur even if there is a 100% match between the donor and recipient. The risk of GVHD is approximately 30%-40% when the donor and recipient are related, and approximately 60%-80% when the donor and recipient are not related.^2-4

Preventing and treating graft-versus-host disease

After a transplant, the patient is usually given medications that suppress the immune system (immunosuppressants) to help prevent GVHD. These medications may be taken for some time, until the doctor decides the risk of GVHD is low. However, immunosuppressants can cause side effects, including damaging the kidneys or liver.^1,3

Immunosuppressants are also used as a treatment option for GVHD. Long-term use of these medications can increase a person's risk of fungal, bacterial, and viral infections. Other treatment options may include corticosteroids.^1,3

While many cases of acute or chronic GVHD can be treated successfully, in some cases, GVHD causes severe damage of the liver, lungs, digestive tract, or other organs. Rarely, GVHD can cause death.^1,4