Graft-versus-host disease

GvHD happens when the donor immune system attacks your body tissues. Graft-versus-host disease doesn’t mean that the transplant has failed. It may even be of benefit, as some of the cells involved in the reaction may also attack any cancer cells that may have survived.

You’ll be prescribed drugs to help prevent GvHD and make it less severe if it occurs. These drugs are called immunosuppressive drugs and work by weakening or dampening down the immune system. Treatment given to prevent problems is called prophylaxis. 

You’ll continue to have immunosuppressive drugs when you go home from hospital. There are a number of different drugs that can be used including:

• Ciclosporin is given as a drip twice a day until your new bone marrow cells start to appear in your blood. It’s then changed to capsules or a liquid.
• Tacrolimus is given as a drip or twice a day as capsules.
• Methotrexate is a type of chemotherapy that’s given in the first few days after a transplant, usually in addition to ciclosporin or tacrolimus. 
• Mycophenolate mofetil (MMF) is given twice a day as a drip or as capsules.

Our cancer support specialists| can give you more information about these drugs and others that may also be used. 

The effects of GvHD are usually mild, but in some people it can become severe and even life-threatening. It mainly affects the skin, mouth, stomach, bowel and liver. The first signs can happen up to six months after your transplant.

Occasionally the donor’s stem cells may be treated (purged) with antibodies to remove the type of white blood cell (T-lymphocyte) doctors think causes GvHD. Removing the T-lymphocytes is usually done if a severe graft-versus-host reaction is possible - for example, if stem cells from an unrelated donor are used.

Acute graft-versus-host disease Back to top

This usually occurs in the first three months after your transplant, but it can happen later than this. It often causes an itchy red skin rash. If the bowel, stomach or liver are affected, you may develop nausea| (feeling sick) and vomiting (being sick), diarrhoea| and a yellowing of the skin and whites of the eyes (jaundice). 

Acute GvHD is more likely to affect you if:

• you have a transplant at an older age
• the donor is unrelated or not such a close match to you. 

It’s usually graded depending on how severe it is. Grade 1 is mild and may not need treatment, and in grade 2, the symptoms are moderate. Grade 3 is severe, and grade 4 is very severe. If you develop acute GvHD at grade 2 or above, you’ll usually have treatment involving medicines such as steroids |to suppress the immune reaction. You may need to be admitted to hospital for monitoring and support with the symptoms. 

Chronic graft-versus-host disease Back to top

Chronic GvHD happens more than 100 days after the transplant. It can develop after acute GvHD, but it sometimes occurs even when a person hasn’t had acute GvHD. Chronic GvHD can affect different parts of the body, causing some of the symptoms listed below. It’s unlikely you’ll develop all of these. Possible symptoms include:

• skin problems including dryness, flaking and ulcers
• breathlessness and asthma-like symptoms 
• a dry and swollen mouth and mouth ulcers
• gritty and dry eyes
• diarrhoea, stomach cramps, feeling sick (nausea) and loss of appetite
• repeated infections
• muscle weakness and joint pain
• vaginal narrowing and dryness in women.

It’s usually treated with steroids and other medicines to control the immune system.