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Several types of cancers (including leukemia) are treated with allogeneic stem cell transplantation. During this procedure, a person receives new blood cells from a donor. Graft-versus-host disease (GVHD) is a condition that may develop in a person who undergoes this type of transplant.
In GVHD, the donated cells see the recipient’s own cells as foreign and attack them. GVHD can be life-threatening or low-grade. Treatments are available that can help keep GVHD under control.
Read on to learn more about GVHD, including symptoms, causes, and treatments, as well as risk factors and ways to prevent this complication.
Graft-versus-host disease is a complication that can occur after stem cell transplantation. GVHD can also occur after other procedures, including organ transplants or blood transfusions — especially in immunocompromised people — although this is less common.
GVHD occurs because of an immune system reaction. It may occur when donor cells (especially donor T cells) react to the recipient’s tissues after an allogeneic transplant (a transplant donor’s stem cells rather than your own). These transplanted stem cells eventually produce new blood cells, including mature T cells (white blood cells that are involved in immune responses).
Typically, your T cells “know” not to attack your body’s own cells because they recognize the proteins called human leukocyte antigens (HLAs) on their surfaces. Each person has unique HLA proteins, so the new T cells have the donor’s HLA proteins, which look different from your own. The new T cells think that your body’s cells are foreign cells, and they attack. This leads to a range of symptoms and health problems.
Your risk of GVHD after an allogeneic stem cell transplant is usually related to how close of a match your donor is. Your chance of developing GVHD if you’re related to your donor may be between 35 percent and 45 percent. But rates vary significantly based on donor type, graft source, conditioning, and other factors.
If you have an unrelated donor, your chance of developing GVHD may be between 60 percent and 80 percent. However, GVHD can occur even with a good HLA match because immune reactions can also be triggered by non-HLA (minor) antigen differences.
Graft-versus-host disease is very rare after an autologous transplantation (transplant using your own cells).
Some people have HLA proteins that look more similar to your own. These donors are a better match, and receiving their cells reduces your risk of developing GVHD. Having a donor who is related to you, who’s a very close HLA match, reduces your risk of GVHD.
Other risk factors may increase your chances of developing GVHD:
If you’re considering undergoing a stem cell transplant, ask your doctor about the risks and benefits you can expect.
GVHD can cause a wide range of symptoms. These symptoms vary depending on the type of GVHD and which organs are affected. If you have acute GVHD, you may experience:
People with chronic GVHD can experience:
This is by no means a complete list — chronic GVHD can affect a wide variety of organs and other parts of the body, causing genital symptoms, nail/hair changes, muscle weakness and fatigue, and many other symptoms. Lab tests also may uncover additional signs of dysfunction.
In some cases, graft-versus-host disease can cause long-term problems. Some people with GVHD are left with damage to organs like the liver, lungs, or digestive system.
There are two forms of graft-versus-host disease: acute and chronic. Acute GVHD is diagnosed through a combination of timing and clinical features — it commonly appears soon after a transplant. If GVHD develops more than 100 days after a transplant, doctors may call it late acute GVHD.
Chronic GVHD takes longer to develop but generally appears within a year of getting a transplant. In some cases, a person has overlap chronic GVHD, in which signs of both acute and chronic GVHD appear at the same time.
Chronic GVHD can be mild, but it’s still a serious complication that clinicians work to prevent. Donated T cells that are just a little active may not attack the healthy cells in your body — but they may aggressively attack your remaining cancer cells. This is known as the graft-versus-leukemia effects, and people who experience it may be less likely to have a relapse (when cancer returns).
If you undergo stem cell transplantation, your doctor will monitor you with different tests to help diagnose GVHD or ensure that it’s under control.
Tests may include:
GVHD treatment varies based on a person’s symptoms and type. Early diagnosis and treatment may help stop GVHD from becoming too severe. In some cases, such as a person undergoing a bone marrow transplant for leukemia, there may be proactive treatments to help prevent GVHD.
Acute graft-versus-host disease is often treated with immunosuppressants (medications that reduce the activity of the immune system). Many immunosuppressants are systemic treatments in the form of corticosteroids.
Some people only have GVHD skin symptoms. These symptoms may be treated with a topical (applied directly to the skin) steroid, another medication, or moisturizers or antihistamines.
Mild cases of chronic graft-versus-host disease may not require ongoing treatment. People with skin symptoms can be treated with topical steroids, and people with eye symptoms can use eye drops that contain immunosuppressants.
More severe cases of chronic GVHD are usually treated first with prednisone. If this steroid doesn’t reduce symptoms, then a person with GVHD may be able to take other immunosuppressants.
Long-term immunosuppression makes your immune system less effective, so these treatments may increase your risk for infections. If your doctor prescribes immunosuppressive medications, they will also probably give you other treatments that help prevent infections.
People with GVHD have a wide variety of outcomes, usually related to the severity of the condition. Some cases of GVHD are mild, while others are life-threatening. The match quality of the donor cells is also a factor — the closer the match to your own cells, the less serious your GVHD is likely to be.
Chronic GVHD can be debilitating (cause significant weakness and sickness). Some people with severe chronic GVHD have painful symptoms that last for years.
In recent years, survival rates for people with GVHD have improved. One recent study found that 79 percent of people with severe acute GVHD live at least two years and that 73 percent of people with moderate to severe chronic GVHD live at least two years.
On MyLeukemiaTeam, people share their experiences with leukemia, get advice, and find support from others who understand.
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Bill it is but oh my, but then I got Covid-19 from the hospital and I will be with it for a total of 90 days which means I will not get to go home until the end of July or the beginning of August… read more
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