Graft Versus Host Disease: Cause, Classifications, and Treatment

Graft Versus Host Disease (GVHD) is the result of a bone marrow transplant or cord blood transplant. It occurs when a donator’s cells or cord blood are used in a transplant situation and the patient’s cells begin to attack the foreign cells. GVHD can affect the eyes, skin, stomach, and intestinal organs of the patient. The course of GVHD can be anywhere from mild to fatal.

Cause of Graft Versus Host Disease

The immune system has a built-in radar to identify what cells should be present in the body, and which should not. If the radar, called HLA antigens, detects foreign cells, it will start an attack to get rid of the invaders. The major culprits in a donor’s blood for passing on GVHD are T-cells. It is for this reason that finding the right donor is so important for any type of transplant. You want to find someone who matches your body’s makeup as closely as possible, as this can greatly reduce your risk of GVHD.

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Here are some other ways to reduce the risk of contracting GVHD:

• Use of umbilical cord blood
• Use of prevention drugs before a transplant, such as methotrexate or cyclosporine
• Removal to T-cells from the donor’s blood before a transplant

The Classifications of Graft Versus Host Disease

GVHD is classified in two main categories, acute and chronic forms (Graft Versus Host Disease, National Marrow Donor Program). In acute GVHD, a patient will display signs within 100 days of the transplantation surgery. Common symptoms might include dry eyes and jaundice (affecting the liver), cramping, nausea, and diarrhea (affecting the intestinal tract), as well as a severe rash that often times starts on the hands and palms, and can erupt into blisters. It has proven beneficial to give patients prevention drugs up to six months after transplant surgery to reduce the risk of contracting acute GVHD.

Chronic GVHD is characterized by a rash or change in skin texture, dry/irritated eyes, and sensitivity involving the mouth. This form of GVHD may not be recognized until up to three months post-transplant. Because sun exposure can greatly increase the chance for contracting GVHD, patients should always wear at least 15-SPF sunscreen or greater.

Advanced stages of chronic GVHD might include hardening of the skin and difficulty moving the extremities. A patient might also experience thinning hair, unexplained weight loss, and brittle fingernails. If these symptoms do occur, you should contact your transplant specialist as soon as possible to begin treatment immediately.

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Treatment of Graft Versus Host Disease

The first line of treatment is the use of steroids, which weaken the immune system without damaging the new marrow (MedlinePlus, U.S. National Library of Medicine and National Health Institutes). Unfortunately, chronic use of steroids can produce its own set of side effects and should be monitored closely by your physician. Much of dealing with GVHD is learning to live with your symptoms and the side effects of medication. It is important to realize that many of the side effects you experience on steroids will dissipate when treatment is stopped.

Research is underway to hopefully discover other treatment options that work on a consistent basis. For this reason clinical trials may be offered to post-transplant patients to identify these treatment alternatives.

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