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An allogeneic stem cell transplant (alloSCT) can be a life-changing treatment for some people with leukemia. It may help your body make healthy blood cells after blood cancer treatment. An alloSCT may also help fight cancer cells that are still in your body.
Also called a bone marrow transplant, an alloSCT replaces your blood-forming stem cells with stem cells from a healthy, compatible donor.
Despite its benefits in many cases, alloSCT still has risks. Graft-versus-host disease (GVHD) is a complication of alloSCT that happens when the donor immune system cells attack your body. GVHD symptoms can range from mild to life-threatening.
GVHD is somewhat common and can’t always be prevented. However, there are steps your cancer care team can take to lower your risk for GVHD and treat it if it develops. This article covers six common GVHD treatment options.
GVHD is a common complication affecting up to 80 percent of people who get an alloSCT. Although severe cases of GVHD can be life-threatening, developing GVHD can also mean that your leukemia treatment is working. Having GVHD may also mean you have a lower risk of recurrence (also known as relapse — when cancer comes back).
There are two types of GVHD: acute graft-versus-host disease and chronic graft-versus-host disease.
Acute GVHD typically shows up within the first 100 days after your transplant. It most often affects the gastrointestinal (GI) tract, skin, or liver.
Chronic GVHD often shows up within two years of the transplant and can affect many organs, including your GI tract, liver, lungs, and joints.
GVHD may not always be preventable. However, it’s possible to lower your risk with several strategies. Careful treatment planning and certain medications may help improve your chances of recovering from an alloSCT without developing acute or chronic GVHD.
GVHD affects up to 80 percent of people who get an alloSCT.
Acute GVHD typically shows up within the first 100 days after a transplant.
Chronic GVHD often shows up within two years of a transplant.
Your transplant team will plan to lower your risk of developing GVHD. Your risk of GVHD is increased if cells from an unrelated donor are used or if the donor is related to you but has highly mismatched human leukocyte antigens (HLAs). HLAs are proteins on cells that help doctors identify donors for transplants.
Your transplant team will try to lower your risk of GVHD by choosing a donor with HLA patterns that match yours as closely as possible. They’ll also prescribe immunosuppressants. These medications calm the immune system and lower the chance that donor cells will attack your tissues.
Researchers continue to study new drugs and new combinations of drugs to prevent GVHD. For example, a 2023 clinical trial identified a new combination of three medications to prevent GVHD.
After one year, 53 percent of people who received the new drug combination had not developed GVHD or had their cancer come back. In the group that received the standard treatment with two drugs, only 35 percent didn’t have GVHD or a cancer relapse.
If you develop GVHD after a bone marrow transplant for leukemia, doctors can treat it in several ways, even if you’re already taking immunosuppressants. Your treatment depends on which organs and systems are affected by your GVHD and how severe your GVHD symptoms are.
Corticosteroids (steroids), which control inflammation, are often the first treatment given for acute GVHD. Doctors also commonly prescribe them to treat chronic GVHD.
Some steroids are prescribed to target symptoms in specific areas. For example, your doctor might prescribe topical steroids to manage a skin rash from either acute or chronic GVHD. Other steroids, like prednisone, work all over your body. These are called systemic steroids, and they can treat more severe or widespread GVHD symptoms.
You might need to take steroids for years or even for the rest of your life if you have chronic GVHD. When it’s time to stop taking steroids, your doctor will tell you how to lower your dose slowly. This is called tapering.
Stopping steroids too quickly can cause GVHD symptoms to flare up. Tell your doctor if steroids are causing side effects, but don’t stop taking them suddenly.
Calcineurin inhibitors such as cyclosporine are another type of immunosuppressant medication. They can be prescribed to treat GVHD after a bone marrow transplant for leukemia. Your doctor might prescribe a calcineurin inhibitor with a steroid to help reduce the immune system activity that causes GVHD symptoms.
Calcineurin inhibitors block a protein on immune cells called calcineurin. This helps calm the immune response. These medications are mainly used to treat acute GVHD.
Janus kinase (JAK) inhibitors such as ruxolitinib (Jakafi) can treat acute or chronic GVHD after a bone marrow transplant for leukemia, especially when steroids don't work well. Some medications for GVHD are taken by mouth, while others are given through a vein.
JAK inhibitors are immunosuppressants that target specific proteins in the immune system. Unlike some other immunosuppressants, they focus on certain immune signals instead of the whole immune system.
Monoclonal antibodies, including axatilimab-csfr (Niktimvo), are another type of immunosuppressive drug that may be prescribed for chronic GVHD after a bone marrow transplant for leukemia. Your doctor might prescribe axatilimab-csfr if you’ve tried at least two other treatments and your GVHD hasn’t improved.
Axatilimab-csfr works by blocking specific receptors on immune cells called colony-stimulating factor-1 receptors, which helps reduce inflammation. The FDA approved axatilimab-csfr in 2024 to treat chronic GVHD. It’s approved for adults and children who weigh at least 40 kilograms, or about 88 pounds, if at least two previous systemic treatments haven’t worked.
Your doctor might recommend photopheresis for chronic GVHD if immunosuppressants don’t improve your condition. Photopheresis isn’t a medication. It’s a process that involves using light to calm down your lymphocytes. Lymphocytes are white blood cells that are part of your immune system.
Photopheresis for GVHD weakens the immune response from lymphocytes, so they don’t attack other cells as much. The process involves removing white blood cells from your body, treating them with a drug that makes them more sensitive to light, exposing them to ultraviolet light, and then returning them to your system.
Photopheresis can make you more sensitive to the sun, so you’ll have to be extra careful about sun protection after each treatment. It can take up to 12 months to know if photopheresis has improved your GVHD symptoms.
Clinical trials are studies in which researchers test new treatments or combinations of treatments on people. They look at both the safety and the effectiveness compared to currently available treatments.
Your doctor can tell you if there are any current clinical trials for your type of GVHD. They can tell you if you qualify for a clinical trial to treat acute or chronic GVHD based on your overall health, how severe your symptoms are, and which organs are affected.
If you’re considering an alloSCT or have already undergone an alloSCT for leukemia, talk to your doctor about your risk of GVHD. They can tell you more about preventive steps before, during, and after your transplant.
If you develop any new or worsening symptoms after an alloSCT, tell your doctor immediately. They can work with you to treat GVHD using the latest available treatments.
On MyLeukemiaTeam, people share their experiences with leukemia, get advice, and find support from others who understand.
Which treatments have you used to treat GVHD after a bone marrow transplant for leukemia? Let others know in the comments below.
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