Graft-Versus-Host Disease (GVHD)
A complication of stem cell and bone marrow transplants
Quick Facts
- Type: Transplant complication / immune reaction
- Occurs after: Donor stem cell or bone marrow transplant
- Commonly affects: Skin, gut, and liver
- Forms: Acute and chronic
Overview
Graft-versus-host disease (GVHD) is a condition that can develop after a person receives a transplant of stem cells or bone marrow from a donor. In these transplants, the donated cells include immune cells. Sometimes these donor immune cells recognize the recipient's tissues as foreign and begin to attack them, causing inflammation and damage.
GVHD is divided into acute and chronic forms based on when it appears and how it behaves. It most often affects the skin, digestive tract, and liver. While GVHD is a serious complication, a degree of donor immune activity can also help fight remaining cancer cells, so treatment aims to control the harmful reaction while preserving benefit. Doctors take many steps before and after transplant to lower the risk.
Symptoms
Symptoms depend on which organs are affected and whether the disease is acute or chronic:
- Skin: Rash, redness, itching, blistering, or thickened, tight skin.
- Digestive tract: Nausea, vomiting, diarrhea, abdominal cramping, and poor appetite.
- Liver: Yellowing of the skin and eyes (jaundice) and abnormal liver tests.
- Chronic GVHD: Dry eyes and mouth, hair and nail changes, joint stiffness, and lung problems.
Acute GVHD usually appears in the first weeks to months after transplant, while chronic GVHD develops later and can be long-lasting.
Causes
GVHD is caused by an immune reaction following a transplant of cells from another person (an allogeneic transplant):
- Donor immune cells: T cells in the donated graft identify the recipient's tissues as foreign and attack them.
- Tissue mismatch: Differences between the donor's and recipient's tissue markers make this reaction more likely.
It does not occur with a person's own cells (an autologous transplant). Rarely, a similar reaction can follow blood transfusions in people with weakened immune systems.
Risk Factors
- A greater genetic mismatch between donor and recipient
- An unrelated rather than closely matched related donor
- Older age of the recipient or donor
- Use of donor cells collected from the bloodstream rather than bone marrow, in some cases
- Previous acute GVHD, which raises the risk of the chronic form
Diagnosis
Doctors diagnose GVHD based on the timing after transplant, the pattern of symptoms, and tests to confirm and rule out other causes:
- Physical exam: Assessing the skin, gut, and signs of liver involvement.
- Biopsies: Small tissue samples from the skin, gut, or liver to confirm the diagnosis.
- Blood and liver tests: To check organ function and look for other causes such as infection.
Treatment
Treatment aims to calm the overactive donor immune cells while keeping enough immune function to fight infection and any remaining cancer:
- Corticosteroids: The main first-line treatment to reduce inflammation.
- Other immune-suppressing medications: Added when steroids are not enough.
- Supportive care: Skin care, nutrition support, eye and mouth care, and treatment of symptoms.
- Infection prevention: Because treatment suppresses immunity, careful monitoring and preventive measures against infection are essential.
Care is provided by a specialized transplant team, and treatment is adjusted based on severity and response.
Prevention
- Careful matching of donor and recipient before transplant
- Preventive immune-suppressing medications given around the time of transplant
- Sometimes removing certain immune cells from the donated graft
- Close monitoring after transplant so GVHD can be caught and treated early
- Following the transplant team's medication and infection-prevention plan exactly
When to See a Doctor
If you have had a transplant, contact your transplant team promptly for any new rash, persistent diarrhea, abdominal pain, yellowing of the skin or eyes, dry or painful eyes and mouth, or unusual symptoms, as early treatment of GVHD works best. Seek emergency care for high fever, signs of serious infection, severe diarrhea with dehydration, trouble breathing, or severe abdominal pain, since people after transplant are especially vulnerable to life-threatening complications.
Frequently Asked Questions
What is graft-versus-host disease?
It is a complication of a donor stem cell or bone marrow transplant in which the donor's immune cells attack the recipient's body. It most commonly affects the skin, digestive tract, and liver.
Who can get GVHD?
GVHD can affect people who receive stem cells or bone marrow from another person, known as an allogeneic transplant. It does not occur when people receive their own cells, and the risk is higher with a greater tissue mismatch between donor and recipient.
What is the difference between acute and chronic GVHD?
Acute GVHD usually develops in the first weeks to months after transplant and often affects the skin, gut, and liver. Chronic GVHD appears later, can last a long time, and may affect many organs, including the eyes, mouth, joints, and lungs.
How is GVHD treated?
The main treatment is corticosteroids to reduce the overactive immune reaction, with other immune-suppressing medications added if needed. Supportive care and careful infection prevention are also important because treatment lowers the body's defenses.
Can GVHD be prevented?
The risk is reduced by carefully matching donor and recipient, giving preventive immune-suppressing medications around the time of transplant, and sometimes adjusting the donated cells. Close monitoring afterward allows early treatment if it does occur.
References
- National Cancer Institute (NCI). Graft-versus-host disease.
- Mayo Clinic. Graft-versus-host disease — Symptoms and causes.
- Leukemia & Lymphoma Society. Graft-versus-host disease.
- MedlinePlus, U.S. National Library of Medicine. Graft-versus-host disease.