One of the functions of bone marrow is that it contains the immune system. The immune system is the body's defense network against foreign invaders. When you are transplanted with a new bone marrow, you are also receiving the immune system of your donor. Once the new bone marrow starts to grow and produce immune cells, there is a chance that the new immune system will recognize your body as "foreign" and mount an attack against it. This attack is called "graft versus host disease" or GVHD.
What is Graft Versus Host Disease (GVHD)?
GVHD occurs because the donor and recipient are not completely the same even if they are "tissue type matched." GVHD tends to occur more often when the donor and recipient's tissue types are not perfectly matched. The older you are, the greater the chance that you might develop GVHD.
During your transplant you will receive medications to try and prevent GVHD from occurring. Starting the day before your transplant you will receive an immunosuppression medication (cyclosporine or tacrolimus). For the first 10 to 14 days, you will be given this medication intravenously. For the first 10 to 14 days, you will be given this medication intravenously.
When you are able to take pills again and before you are discharged from the hospital, you will begin to take your cyclosporine or tacrolimus orally. Other chemotherapy medications may also be used after the stem cell infusion to suppress immune cells. Methotrexate, a form of chemotherapy that suppresses immune cells, may be given intravenously on days one (1), three (3), and six (6) after the marrow infusion. Alternatively, you may receive cyclophosphamide intravenously on days three (3) and four (4). These medications work by suppressing the new immune system. If you develop GVHD, the usual treatment is prednisone, a steroid which also acts to suppress the immune system. Other drugs may be used as well.
There are two kinds of GVHD: acute and chronic. Acute GVHD occurs within the first 20-100 days after the transplant. Any GVHD present or occurring after 100 days is called chronic GVHD. The organs usually affected are the skin, gastrointestinal tract, liver and, rarely, the lungs.
Most cases of GVHD are mild or moderate and that both the effects of the disease, and the side effects of the drugs used to treat it, are often temporary.
GVHD is common after an allogeneic transplant and varies from being mild to severe.
Because chronic GVHD usually develops more than 100 days after transplant when you are no longer having weekly visits with the transplant team, it's important that you examine your body regularly for signs of GVHD.
Carefully inspect your mouth, eyes, skin, joints and genitals for any changes. Don’t ignore subtle changes. Report anything unusual to your doctor immediately.
Don’t be afraid to ask questions. If you notice a change, don’t assume it’s nothing to worry about. Ask your care team to be sure.
Signs and symptoms of GVHD include:
- Red skin rash that appears on the upper chest and shoulder but can start on and spread to other parts of the body. The skin is often itchy, dry, irritated and may peel like after a bad sunburn.
- Fatigue
- Decreased appetite
- Diarrhea
- Abdominal cramps
- Weight loss
- Jaundice
- Pain in the right, upper part of the abdomen.
With chronic GVHD, you can also experience:
- Dry, burning eyes
- Dryness or sores in the mouth
- Burning sensations when eating acidic or spicy foods.
Recognizing the signs and symptoms of GVHD and reporting them early may help to control the disease better. If you notice a new onset of any of the following conditions, notify your transplant team promptly.
Acute and chronic signs symptoms of GVHD by affected organ
| Affected Organ | Acute GVHD | Chronic GVHD |
|---|---|---|
| Skin |
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| Gastrointestinal tract |
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| Liver |
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| Lungs (uncommon) |
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