CancerQuest | BMT: Graft-Versus-Host Disease (GVHD)

Graft-versus-host disease is a condition that can develop after allogenic stem cell transplant. It occurs when donor-derived T cells attack the recipient tissue⁽¹⁾. There are two types of graft-versus host disease; acute GVHD (aGVHD) and chronic GVHD (cGVHD). The difference between acute and chronic disease is the time of onset after transplantation; aGVHD occurs before day 100 and cGVHD after day 100. This definition is not completely accurate. Acute symptoms may occur past day 100 and some patients may experience an overlap of symptoms. Acute and chronic GVHD are responsible for most of the complications of stem cell transplantation. It is extremely important to discuss any issues with a health care professional.

Although GVHD is thought of as a negative side-effect, low-grade GVHD is actually associated with a lower rate of relapse. This is due to what is called the graft-versus-malignancy effect, where the donor-derived T cells attack the malignant cells (leukemia cells, myeloma cells, etc.)⁽²⁾

Acute GVHD (aGVHD)
All patients undergoing an allogenic stem cell transplant are at risk for developing aGVHD. Patients with one HLA mismatch (5 out of 6) are at a higher risk than those with an identical HLA match (6 out of 6). Other risk factors include patient and donor age, preparatory regimen, and the source of cells. The skin, gastrointestinal tract, and liver are the sites most often affected by aGVHD⁽²⁾.

Skin aGVHD symptoms: rash: red, raised, itchy, and/or painful. Frequently begins on the hands and feet and spreads to the abdomen, chest, and upper back.
Gastrointestinal aGVHD symptoms: diarrhea, loss of appetite, nausea, and vomiting. Can lead to gastrointestinal bleeding.
Liver aGVHD symptoms: high levels of bilirubin, high levels of alkaline phosphate. Can lead to liver failure.

Chronic GVHD (cGVHD)
Chronic GVHD is considered an autoimmune disorder and it is the most common cause of long-term complications after transplant. A history of acute GVHD is the most important predictor of cGVHD development. Other risk factors are the same as aGVHD; patient and donor age, preparatory regimen, and source of cells. Most organ systems can be affected by cGVHD. This Long Term Survival Guidelines resource from the National Marrow Donor Program has a thorough list of symptoms of cGVHD as well as great advice on what to do after transplant.