Graft-versus-host disease

Definition

Graft-versus-host disease (GVHD) is a life-threatening complication that can occur after certain stem cell or bone marrow transplants.

Alternative Names

GVHD; Bone marrow transplant - graft-versus-host disease; Stem cell transplant - graft-versus-host disease; Allogeneic transplant - GVHD

Causes

GVHD may occur after a bone marrow, or stem cell, transplant in which someone receives bone marrow tissue or cells from a donor. This type of transplant is called allogeneic. The new, transplanted cells regard the recipient's body as foreign. When this happens, the cells attack the recipient's body.

GVHD does not occur when people receive their own cells. This type of transplant is called autologous.

Before a transplant, tissue and cells from possible donors are checked to see how closely they match the recipient. GVHD is less likely to occur, or symptoms will be milder, when the match is close. The chance of GVHD is:

Around 35% to 45% when the donor and recipient are related
Around 60% to 80% when the donor and recipient are not related

Symptoms

There are two types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.

Acute GVHD usually happens within days or as late as 6 months after a transplant. The immune system, skin, liver, and intestines are mainly affected. Common acute symptoms include:

Abdominal pain or cramps, nausea, vomiting, and diarrhea
Jaundice (yellow coloring of the skin or eyes) or other liver problems
Skin rash, itching, redness on areas of the skin
Increased risk for infections

Chronic GVHD usually starts more than 3 months after a transplant, and can last a lifetime. Chronic symptoms may include:

Dry eyes, burning sensation, or vision changes
Dry mouth, white patches inside the mouth, and sensitivity to spicy foods
Fatigue, muscle weakness, and chronic pain
Joint pain or stiffness
Skin rash with raised, discolored areas, as well as skin tightening or thickening
Shortness of breath due to lung damage
Vaginal dryness
Weight loss
Reduced bile flow from the liver
Brittle hair and premature graying
Damage to sweat glands
Cytopenia (decrease in number of mature blood cells)
Pericarditis (inflammation in the membrane surrounding the heart; causes chest pain)

Exams and Tests

Several lab and imaging tests can be done to diagnose and monitor problems caused by GVHD. These may include:

A biopsy of the skin, mucous membranes in the mouth, may also help to confirm the diagnosis.

Treatment

After a transplant, the recipient usually takes medicines, such as prednisone (a steroid), which suppress the immune system. This helps reduce the chances (or severity) of GVHD.

You'll continue taking the medicines until your health care provider thinks the risk for GVHD is low. Many of these medicines have side effects, including kidney and liver damage. You'll have regular tests to watch for these problems.

Outlook (Prognosis)

Outlook depends on the severity of GVHD. People who receive closely matched bone marrow tissue and cells usually do better.

Some cases of GVHD can damage the liver, lungs, digestive tract, or other body organs. There is also a risk for severe infections.

Many cases of acute or chronic GVHD can be treated successfully. But this doesn't guarantee that the transplant itself will succeed in treating the original disease.

When to Contact a Medical Professional

If you have had a bone marrow transplant, call your provider right away if you develop any symptoms of GVHD or other unusual symptoms.

References

Bishop MR, Keating A. Hematopoietic stem cell transplantation. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 168.

Im A, Pavletic SZ. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 28.

Reddy P, Ferrara JLM. Graft-versus-host disease and graft-versus-leukemia responses. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 108.