What are the symptoms of graft versus host disease?

Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow transplant, where the donated cells (the graft) attack the recipient’s body (the host). GVHD can affect many different parts of the body and can cause a wide range of symptoms. The symptoms of GVHD can be acute (occurring within the first 100 days after transplant) or chronic (occurring after the first 100 days).

Acute GVHD symptoms may include:

1. Skin rash: A rash that may be itchy and red, often starting on the palms of the hands or soles of the feet and spreading to other parts of the body.
2. Diarrhea: Frequent, watery stools that may be accompanied by abdominal pain, cramping, or bloating.
3. Nausea and vomiting: Feeling sick to your stomach and vomiting.
4. Jaundice: Yellowing of the skin and whites of the eyes, which can indicate liver damage.
5. Mouth sores: Painful sores or ulcers in the mouth or throat.
6. Dry or irritated eyes: Eyes that feel dry, gritty, or irritated.

Chronic GVHD symptoms may include:

1. Skin changes: Dry, scaly, or thickened skin, as well as changes in skin color.
2. Joint pain: Pain, stiffness, or swelling in the joints.
3. Mouth and esophageal problems: Difficulty swallowing, dry mouth, or oral infections.
4. Vision changes: Blurred vision, sensitivity to light, or other vision problems.
5. Chronic diarrhea: Persistent, watery stools that may be accompanied by abdominal pain or cramping.
6. Fatigue: Persistent tiredness or lack of energy.

The severity of GVHD symptoms can vary from person to person, and some individuals may experience mild symptoms while others may have more severe symptoms that require treatment. It’s important for individuals who have had a stem cell or bone marrow transplant to be aware of the signs and symptoms of GVHD and to report any new or worsening symptoms to their healthcare provider. Early detection and treatment of GVHD by your healthcare provider can help improve outcomes.

What are the causes of graft versus host disease?

Graft-versus-host disease (GVHD) occurs when the immune cells from the donated stem cells or bone marrow (the graft) attack the recipient’s tissues and organs (the host). GVHD is most commonly associated with allogeneic stem cell or bone marrow transplants, where the donor and recipient are not identical twins.

There are two main types of GVHD:

1. Acute GVHD: Acute GVHD typically occurs within the first 100 days after transplant. It is often triggered by the interaction between the donor’s immune cells (T cells) and the recipient’s tissues. The exact cause of acute GVHD is not fully understood, but it is thought to involve a complex interplay of factors, including:

• Differences in the human leukocyte antigen (HLA) types between the donor and recipient, which can trigger an immune response.
• Conditioning regimen: The pre-transplant chemotherapy or radiation therapy used to prepare the recipient’s body for the transplant can damage tissues and release inflammatory signals that activate the donor’s immune cells.
• Activation of donor T cells: The donor’s T cells may become activated and attack the recipient’s tissues, particularly the skin, liver, and gastrointestinal tract.

1. Chronic GVHD: Chronic GVHD occurs after the first 100 days following transplant and can persist for months or years. Chronic GVHD is thought to result from dysregulation of the immune system, leading to ongoing inflammation and tissue damage. Risk factors for chronic GVHD include:

• Prior acute GVHD
• HLA mismatch between donor and recipient
• Older age of the recipient or donor
• Female donor for a male recipient (or vice versa)
• Certain genetic factors

Chronic GVHD is less well understood than acute GVHD, and the exact causes are still being studied.

GVHD can affect many different organs and tissues in the body, including the skin, liver, gastrointestinal tract, lungs, and eyes. The severity of GVHD can vary widely, from mild skin rashes to life-threatening complications affecting multiple organs. Treatment for GVHD typically involves immunosuppressive medications to suppress the donor’s immune response and reduce inflammation in the affected tissues.

What is the treatment for graft versus host disease?

The treatment for graft-versus-host disease (GVHD) depends on several factors, including the severity of the disease, the organs involved, and the overall health of the patient. Treatment may involve a combination of medications and other therapies to suppress the immune response and reduce inflammation. Some common treatments for GVHD include:

1. Immunosuppressive medications: Drugs such as corticosteroids (e.g., prednisone), calcineurin inhibitors (e.g., cyclosporine, tacrolimus), and other immunosuppressants (e.g., mycophenolate mofetil, sirolimus) are often used to suppress the immune response and reduce inflammation in GVHD. These medications are usually taken orally or given intravenously.
2. Phototherapy: Phototherapy, also known as photopheresis, is a treatment that involves removing white blood cells from the patient’s blood, treating them with ultraviolet light, and then returning them to the patient. Phototherapy is thought to suppress the immune response and reduce inflammation in GVHD.
3. Topical treatments: For GVHD affecting the skin, topical corticosteroids or other medications may be applied directly to the affected areas to reduce inflammation and promote healing.
4. Biological therapies: Drugs such as infliximab or rituximab, which target specific components of the immune system, may be used in some cases of GVHD that do not respond to other treatments.
5. Supportive care: Supportive care, such as hydration, nutritional support, and pain management, may be needed to help manage symptoms and improve quality of life.

In severe cases of GVHD that do not respond to standard treatments, more intensive therapies such as high-dose corticosteroids, other immunosuppressive agents, or even a second stem cell transplant may be considered. However, these treatments carry risks and are usually reserved for cases where the potential benefits outweigh the risks.

The goal of treatment for GVHD is to control symptoms, prevent complications, and improve quality of life. Treatment is often managed by a multidisciplinary team of healthcare providers, including hematologists, transplant specialists, dermatologists, and others, to provide comprehensive care tailored to the individual patient’s needs.