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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Graft-versus-host disease

Last reviewed: June 5, 2012.

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 transplant recipient's body.

Causes, incidence, and risk factors

GVHD may occur after a bone marrow or stem cell transplant in which someone receives bone marrow tissue or cells from a donor (called an allogeneic transplant). The new, transplanted cells regard the recipient's body as foreign. When this happens, the newly transplanted cells attack the recipient's body.

GVHD does not occur when someone receives his or her own cells during a transplant (called an autologous transplant).

Before a transplant, tissue and cells from possible donors are checked to see how closely they match the person having the transplant. GVHD is less likely to occur, or symptoms will be milder, when the match is close. The chance of GVHD is:

  • Very low when a person receives bone marrow or cells from an identical twin
  • Around 30 - 40% when the donor and recipient are related
  • Around 60 - 80% when the donor and recipient are not related

Symptoms

There are two types of GVHD: acute and chronic. Symptoms in both acute and chronic GVHD range from mild to severe.

Acute GVHD usually happens within the first 3 months after a transplant. Common acute symptoms include:

Chronic GVHD usually starts more than 3 months after a transplant, and can last a lifetime. Chronic symptoms may include:

  • Dry eyes or vision changes
  • Dry mouth, white patches inside the mouth, and sensitivity to spicy foods
  • Fatigue, muscle weakness, and chronic pain
  • Skin rash with raised, discolored areas, as well as skin tightening or thickening
  • Shortness of breath
  • Vaginal dryness
  • Weight loss

Signs and tests

Several lab and imaging tests can be done to diagnose and monitor problems caused by GVHD.

A biopsy of the skin, mucus membranes in the mouth, or other parts of the body may help confirm the diagnosis.

Treatment

After a transplant, the recipient usually takes drugs that supress the immune system. This helps reduce the chances (or severity) of GVHD.

A number of medicines and other treatments are often started after the transplant. You will continue taking the medicines until your health care provider thinks the risk of GVHD is low. Many of these medicines have side effects, including kidney and liver damage. You will have tests to watch for these problems on a regular basis.

Treatment of chronic GVHD includes prednisone (a steroid), or the same drugs that suppress the immune system.

Expectations (prognosis)

How well a person does depends on the severity of GVHD. The outlook is better for patients who receive closely matched bone marrow tissue and cells. 

Some cases of GVHD can damage the liver, lungs, digestive tract, or other body organs. Patients may also be at risk for severe infections.

However many cases, acute or chronic, can be treated successfully.

Successful treatment of GVHD does not guarantee that the transplant itself will succeed in treating the original disease.

Calling your health care provider

If you have had a bone marrow or stem cell transplant, call your health care provider right away if you develop any symptoms of GVHD or other unusual symptoms.

References

  1. Sykes M. Transplantation immunology. In Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 48.

Review Date: 6/5/2012.

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

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  • Extracorporeal photopheresis treatment for chronic graft‐versus‐host disease after haematopoietic stem cell transplantation in paediatric patients
    Chronic graft‐versus‐host disease is a common complication after haematopoietic stem cell transplantation (HSCT; transplant of blood‐forming stem cells). Immune cells (white blood cells) from the donor recognise the patient's cells as foreign ("non‐self"). Therefore, the transplanted immune cells attack the cells of the patient. The main affected organs are skin, liver and gut, among other organ tissues. These immune reactions may cause acute inflammation followed by chronic changes of the organs (e.g. fibrosis). First‐line therapy usually consists of immunosuppressive drugs in the form of corticosteroids in combination with other immunosuppressive agents in refractory cases (where the disease is resistant to treatment). The use of these immunosuppressive drugs is designed to suppress the immune‐mediated attack of the patient's cells. Limited effectiveness and severe side effects of these immunosuppressive drugs have led to the application of several alternative approaches. Extracorporeal photopheresis (ECP) is an immunomodulatory therapy that involves collection of immune cells from peripheral blood outside the patient's body. These immune cells are exposed to a photoactive agent (a chemical that responds to exposure to light; e.g. 8‐methoxypsoralen) with subsequent ultraviolet‐A radiation and then re‐infused. The immunomodulatory effects of this procedure have not been completely elucidated. Several current clinical practice recommendations suggest consideration of ECP in paediatric patients with chronic graft‐versus‐host disease.
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