Graft vs. Host Disease: Symptoms, Causes, Treatment

What are the symptoms of graft vs. host disease?

Graft-versus-host disease (GVHD) is a complication that can occur after a stem cell or bone marrow transplant in which the newly transplanted donor cells attack the recipient’s body. The symptoms of GVHD can vary depending on whether it is acute or chronic GVHD and which parts of the body are affected.

Acute GVHD typically occurs within the first few months after transplantation and often affects the skin, gastrointestinal tract, and liver. Symptoms may include:

• Skin rash, itching, or redness
• Jaundice (yellowing of the skin or eyes)
• Diarrhea, abdominal pain, or nausea
• Loss of appetite
• Abnormal liver function tests

Chronic GVHD can develop months to years after transplantation and can affect multiple organs, including the skin, mouth, eyes, lungs, liver, and joints. Symptoms may include:

• Skin changes, such as thickening or hardening of the skin
• Dry, itchy skin
• Mouth sores or difficulty swallowing
• Dry eyes or vision changes
• Shortness of breath or cough
• Abdominal pain or bloating
• Joint pain or stiffness

GVHD can range from mild to severe and can be life-threatening, especially if it affects critical organs such as the lungs, liver, or gastrointestinal tract. Treatment for GVHD typically involves immunosuppressive medications to help control the immune response and reduce inflammation. The prognosis for GVHD varies depending on the severity of the disease and how well it responds to treatment. Close monitoring by a healthcare team experienced in managing GVHD is essential for the best outcomes.

What are the causes of graft vs. host disease?

Graft-versus-host disease (GVHD) is caused by an immune response that occurs when donor cells from a stem cell or bone marrow transplant recognize the recipient’s body as foreign and attack its tissues. The exact causes of GVHD are complex and involve interactions between the donor’s immune cells (graft) and the recipient’s tissues (host).

There are two main types of GVHD:

1. Acute GVHD: Acute GVHD typically occurs within the first 100 days after transplantation. It is thought to be triggered by the activation of donor T cells, a type of white blood cell, which recognize the recipient’s tissues as foreign and mount an immune response. The conditioning regimen used before transplantation, which includes chemotherapy and/or radiation therapy, can damage the recipient’s tissues and release signals that activate the donor T cells.
2. Chronic GVHD: Chronic GVHD can develop months to years after transplantation and is thought to be caused by a dysregulated immune response that leads to inflammation and tissue damage. The exact triggers for chronic GVHD are not well understood but may involve ongoing immune activation and interactions between donor and recipient cells.

Several factors can increase the risk of developing GVHD, including:

• HLA (human leukocyte antigen) mismatch between the donor and recipient
• Use of unrelated or mismatched donors
• Older age of the donor or recipient
• Use of certain conditioning regimens before transplantation
• Previous episodes of acute GVHD

GVHD can affect multiple organs and tissues in the body, including the skin, gastrointestinal tract, liver, and lungs. The severity of GVHD can vary from mild to life-threatening, and treatment typically involves immunosuppressive medications to control the immune response and reduce inflammation.

How is the diagnosis of graft vs. host disease made?

The diagnosis of graft-versus-host disease (GVHD) is typically based on a combination of clinical symptoms, medical history, and diagnostic tests. The diagnosis can be challenging because the symptoms of GVHD can overlap with other conditions, and the severity of GVHD can vary widely from person to person.

1. Clinical Assessment: The doctor will conduct a thorough physical examination and ask about the patient’s medical history, including details about the stem cell or bone marrow transplant and any symptoms the patient is experiencing.
2. Symptoms: GVHD can affect the skin, gastrointestinal tract, liver, and other organs. Common symptoms include skin rash, diarrhea, abdominal pain, nausea, vomiting, jaundice (yellowing of the skin or eyes), and shortness of breath.
3. Biopsy: A biopsy may be performed to confirm the diagnosis of GVHD. This involves taking a small sample of tissue from the affected area, such as the skin, gastrointestinal tract, or liver, and examining it under a microscope. A biopsy can help distinguish GVHD from other conditions that may cause similar symptoms.
4. Blood Tests: Blood tests can help assess organ function and detect signs of inflammation or immune system activity. Liver function tests, complete blood count (CBC), and other tests may be done to help diagnose GVHD and monitor its progression.
5. Imaging Studies: In some cases, imaging studies such as CT scans or MRI scans may be done to evaluate the extent of organ involvement and rule out other possible causes of symptoms.
6. Histocompatibility Testing: If GVHD is suspected, additional testing may be done to evaluate the compatibility between the donor and recipient, including HLA typing and other genetic tests.

Diagnosing GVHD requires a multidisciplinary approach involving specialists in hematology/oncology, transplantation, dermatology, gastroenterology, and other fields. Early detection and prompt treatment are important for managing GVHD and improving outcomes for patients who have undergone stem cell or bone marrow transplantation.

What is the treatment for graft vs. host disease?

Graft-versus-host disease (GVHD) is a common and potentially serious complication of allogeneic bone marrow transplantation (BMT), where the donated bone marrow or stem cells attack the recipient’s body. The treatment for GVHD depends on the severity and extent of the disease, as well as the individual’s overall health and the type of transplant.

Mild GVHD:

• Supportive care: Mild GVHD may be managed with supportive care, such as medications to manage symptoms, hydration, and nutrition.
• Corticosteroids: Low-dose corticosteroids, such as prednisone, may be used to reduce inflammation and alleviate symptoms.

Moderate GVHD:

• Immunosuppressive therapy: Moderate GVHD may require immunosuppressive therapy to reduce the immune response and prevent further damage. This may include:
  • Corticosteroids: Higher doses of corticosteroids may be necessary to control symptoms.
  • Calcineurin inhibitors: Medications like tacrolimus or cyclosporine can help reduce the immune response.
  • Methotrexate: This medication can also be used to suppress the immune system.

Severe GVHD:

• Intensive immunosuppressive therapy: Severe GVHD requires more aggressive treatment to prevent further damage. This may include:
  • High-dose corticosteroids: Higher doses of corticosteroids may be necessary to control symptoms.
  • Antithymocyte globulin (ATG): This medication can help reduce the number of immune cells that are attacking the recipient’s body.
  • Rituximab: This monoclonal antibody can help reduce the number of B cells that contribute to GVHD.
  • Infliximab: This medication can help reduce inflammation and alleviate symptoms.
  • Extracorporeal photopheresis: This is a process that uses light and medication to remove immune cells from the blood and reduce their ability to cause damage.

In addition to these treatments, patients with severe GVHD may also require other forms of support, such as:

• Nutritional support: Patients with severe GVHD may require total parenteral nutrition (TPN) or enteral nutrition to ensure they receive adequate calories and nutrients.
• Pain management: Patients with GVHD often experience significant pain, which can be managed with pain medications and other therapies.
• Psychological support: Patients with GVHD may experience significant emotional distress, which can be addressed with counseling and other forms of psychological support.

It’s important to note that treatment for GVHD is often tailored to the individual patient’s needs and response to therapy. A multidisciplinary team of healthcare providers, including hematologists, oncologists, and transplant specialists, will work together to develop a treatment plan that addresses the patient’s specific needs.