Graft vs host disease (GVHD): symptoms, treatment and more

The transplant in relation to host’s disease (GVHD) can occur after a stem cell transplant of a donor. Transplants replace unhealthy cells with healthy cells forming blood, which can treat certain cancers.

GVHD occurs when transplanted cells recognize cells in your body as foreign and attack them.

GVHD can be acute (short -term) or chronic (long -term). According to the organs it affects, the GVHD can cause many symptoms.

There are two main types of GVHD, classified according to the start of symptoms. Health care providers sometimes use other classifications.

Acute gvhd

Acute GVHD generally develops in the first 100 days of transplantation, but it can develop later in some cases. It affects the skin, the gastrointestinal tract and the liver. About 30 to 70% of people who receive transplantation develop an acute GVHD.

Chronic GVHD

The chronic GVHD can develop at any time after transplantation, but it generally occurs more than 100 days later. Chronic GVHD can affect a single organ or more organs. About 40 to 50% of people undergoing transplantation can develop chronic GVHD.

Other classifications

Health care providers sometimes describe the GVHD by other means. These include:

• Persistent, recurring or late acute gvhd: This type has characteristics similar to acute GVHD but develops more than 100 days after transplantation.
• Overlap: This type can develop at any time after receiving a transplant and has acute and chronic GVHD characteristics.

The symptoms of the transplant in relation to the host disease can vary depending on the type of GVHD and the affected organs. Some of these symptoms can be light, while others can be serious or fatal.

Acute gvhd symptoms

The acute GVHD most often affects the skin, the digestive tract and the liver.

Symptoms of the skin: A rash similar to sunburn can appear on any part of your skin. The eruption can be slightly itchy at the start, but it can become more serious and cause blues or skin peels.

Digestive symptoms: The most common digestive symptom is severe diarrhea. Other digestive symptoms include:

• Nausea
• Pain in your abdomen
• Vomiting
• Loss of appetite
• Blood in the stool

Liver symptoms: The liver problems associated with GVHD normally do not cause symptoms and can only be detected by hepatic function tests. However, serious liver damage can cause symptoms such as:

• Jaundice (yellowing of the skin and whites of the eyes)
• Ascite (accumulation of liquid in the abdomen)
• Mental confusion

Chronic GVHD

Chronic GVHD can affect several organs, which can cause many symptoms. These include:

• Dry mouth, painful wounds, dental caries and difficulty eating and swallowing
• Blurred vision
• Itchy and thickened skin
• Hair loss on the head and body
• Nausea, vomiting, diarrhea and loss of appetite
• Shortness of breath
• Muscle weakness and cramps
• Stiffness
• Genitals itching and painful relations

When you receive a stem cell transplant, your body develops new immune cells from the donor stem cells. If these new immune cells confuse your own cells as foreign, this can trigger an immune response against your body.

This immune response can occur because your immune system is formed to distinguish between its own cells and foreign cells. Your immune system does by recognizing proteins called Human leukocyte antigens (HLAS) which are on the surface of most cells in your body.

Your body’s HLA markers are unique. Unless your donor is a twin, their HLA markers will be different from yours.

Before a stem cell transplant, health care providers Check the compatibility of your cells with donor cells. They do it with the HLA typing, also called fabric typing test, which helps them see how similar your HLA markers are.

Despite these tests, the new immune cells sometimes find that your HLA is too different from theirs, which can trigger an immune response.

Risk factors

Some factors can make GVHD more likely after receiving a transplant. These include:

• Stem cells of an related donor with a HLA lag
• Stem cells of a donor not related with an HLA offset
• More advanced age (for you or the donor)
• A male recipient receiving the transplant from a donor woman (especially if she has already been pregnant)
• A previous diagnosis of acute GVHD

There is no specific test to diagnose the transplant and host’s disease. Instead, a health care provider can diagnose this condition according to your symptoms and different test results.

Your supplier will probably do a physical exam and recommend tests to exclude other conditions that cause similar symptoms, such as infection or liver disease.

The treatment of GVHD depends on factors such as your overall health, the severity of the GVHD and the affected organs. In cases where the symptoms are more serious, you may need to be treated in a hospital.

Health care providers often treat GVHD with immunosuppressive treatments, which are drugs or procedures that reduce the immune response. If these do not work well, they can use other drugs.

Immunosupping treatments

Treatments that can help reduce symptoms by reducing your immune response include:

• Corticosteroids: Steroid drugs Like medrol (methylprednisolone) and deltasone (prednisone) are an essential treatment to help remove immune activity from your body and reduce inflammation. Corticosteroids or topical moisturizers can help the GVHD that affects your skin.
• Calcineurine Inhibitors: Your health care provider may prescribe medicines such as the program (tacrolimus) and cyclosporin, As well as steroids, to remove your immune system.
• Biological: Biologicals, such as interleukin-2 receptor antibodies (IL-2) and tumor necrosis factor inhibitors (TNF) can help reduce inflammation and symptoms by targeting specific proteins or cells in the immune system.
• Antithymocyte globulin:: These drugs help to remove the immune system in serious cases that do not respond to other treatment options.
• Photopherère:: This procedure consists in eliminating white blood cells from your blood, treating them with ultraviolet light and returning them to your body. This process can reduce the immune response and is most often used for people with chronic GVHD.

Other treatments

The United States Food and Drug Administration (FDA) has also approved several other drugs for the treatment of GVHD. These include:

• Imbruvica (ibrutinib): This oral drug can help treat chronic GVHD in adults after one or more traditional treatment approaches have not worked.
• NIKTIMVO (Axatilimab-Csfr): This infused drug can help treat chronic GVHD in adults and children after the failure of at least two previous treatments.
• Ryoncil (Restmcel-l-Rknd): This infused treatment is intended for acute GVHD in children aged 2 months or more.
• Rezurock (Belumosudil): This oral medication can help treat chronic GVHD in adults and children over 12, after two previous or more treatments have not worked.

Your health care provider can help prevent GVHD, ensuring that your donor’s HLA markers closely correspond to yours. The more markers you are and the donor share, the more you risk that your new immune cells of the donor attack your healthy cells.

Your supplier may also recommend immunosuppressive drugs before and after the transplant to help prevent GVHD. Orencia (Demoucept) is a drug approved by the FDA to help prevent acute GVHD.

GVHD can sometimes cause serious complications. These may include:

• Infections: GVHD or its treatment may increase the risk of bacterial, viral and fungal infections.
• Interstitial pulmonary disease: It is a group of pulmonary disorders that cause scars and inflammation in your lungs.
• Obliterating bronchiolitis syndrome (popcorn lung): This rare pulmonary disorder occurs when bronchioles (small respiratory tract in the lungs) become narrow and marked, which can cause respiratory failure.
• Malabsorption: This condition occurs when your body is unable to absorb food nutrients.
• Abnormal motility: With this disorder, the nerves or muscles of your intestinal tract do not work properly, leading to intestinal obstruction.

The way the transplant in relation to host’s disease affects your life may depend on its severity and the symptoms you feel. Early diagnosis and treatment are essential to prevent GVHD from becoming serious.

If you notice unusual symptoms after receiving a transplant, contact a health care provider. They can diagnose and treat your GVHD.