After a donor stem cell transplant, cells from the donor called T-lymphocytes, or T-cells sometimes react against your own cells. This is called graft-versus-host disease (GVHD).
GVHD does not mean the transplant has failed. It can sometimes be helpful. The donor cells may also attack any remaining cancer cells.
There are two forms of GVHD:
- Acute GVHD
This usually develops within the first 100 days (about three months) after transplant. But it may also happen after this time.
- Chronic GVHD
This can start on its own a few months after transplant. Or it can sometimes progress from the acute type.
People who have unrelated or mismatched donor are more likely to develop GVHD. It most often happens after immunosuppressant drugs are stopped. You usually take immunosuppressant drugs for a few months after your transplant. GvHD can also happen after a donor lymphocyte infusion. This is a treatment that is sometimes given to improve how well your donor's cells have engrafted.
The effects of GVHD are usually mild. But in some people they can be severe and even life-threatening. GVHD mainly affects the skin, mouth, stomach, bowel and liver.
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Acute GVHD is most likely to happen in the first 3 months after transplant. But it may develop much later than this. The risk is increased when the donor is not related or is not a close match.
Preventing acute GVHD
Your doctors will give you immunosuppressant drugs to reduce your risk of acute GVHD after your transplant. These help stop your donor’s T-cells from attacking your body tissues.
Having antibody therapy as part of your conditioning treatment can also help reduce the risk of GVHD.
If the risk of severe GVHD is very high, the donor’s T-cells can be removed from the stem cell collection in the laboratory. This could be when stem cells from a mismatched unrelated donor or haploidentical donor are used.
Symptoms of acute GVHD
The symptoms depend on which part or parts of your body are affected. GVHD often causes an itchy skin rash. If your bowel, stomach or liver are affected, you may have sickness and diarrhoea. If the liver is involved, sometimes the whites of your eyes become yellow (jaundiced).
Treating acute GVHD
Acute GVHD is graded by how severe it is. Grade 1 is mild. Grade 4 is very severe.
- If it is mild, you may be treated at home with steroid cream for your skin.
- If it is grade 2 or above, you will usually need treatment with steroids. You may need to be admitted to hospital so that doctors can monitor and treat your symptoms.
If your symptoms do not get better with steroids your doctor will talk to you about other treatments that may help.
This may happen more than three months after your transplant. It can develop from acute GVHD, or happen on its own. Your transplant team will explain what to look out for.
Any symptoms will depend on which parts of the body are affected. They may include:
- skin changes, including dryness, flaking, discolouration, thickening and ulcers
- hair that grows slowly and is brittle or patchy
- a dry and swollen mouth and mouth ulcers
- dry, gritty eyes
- diarrhoea, stomach cramps, sickness and loss of appetite
- feeling short of breath or wheezy.
You might also have more generalised symptoms. These may include repeated infections, muscle weakness and joint pain.
Chronic GVHD is usually treated with steroids and other treatments that help control the immune system. You will also be given treatment and support to manage any symptoms you have.
Extracorporeal photopheresis (ECP) - light treatment
Extracorporeal photopheresis (ECP) is when your blood cells are treated outside your body with special light treatment. Doctors are not sure exactly how it works to treat GVHD. But they know that it changes the immune system without weakening it.
ECP is used more for chronic GVHD. It improves most people's symptoms. Your doctor or nurse will give you more information about the treatment. It is only available in some specialist centres.
Your central line is connected by tubes to a cell separator machine. Blood leaving your body passes through the machine. It is treated with ultraviolet (UV) light and drugs that work when exposed to light.
The treated blood is then returned to you by another tube that also connects to your central line. This continues until all your blood has been treated.
If your central line has already been taken out, your doctor will use a cannula. This is a short, thin tube put into a vein in your arm.
You normally have ECP for 2 days in a row every 2 to 4 weeks.
Below is a sample of the sources used in our stem cell and bone marrow transplants information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Carreras, Dunfour, Mohty and Kröger. The European Society for Blood and Bone Marrow Transplantation: Hematopoietic stem cell transplantation and cellular therapies. Springer, Switzerland. 2019.
FACT-JACIE International Standards for Hematopoietic Cellular Therapy – product collection, processing and administration. 7th edition. 2018.
Anthony Nolan. Operations and patient services user guide. Available from www.anthonynolan.org. Accessed January 2019.
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