Graft-versus-host disease (GvHD)

After a donor stem cell transplant, there’s a possibility that the donor cells will react against your own. This is known as graft-versus-host disease (GvHD). GvHD doesn’t mean that the transplant has failed. It can even have benefits, as the donor cells may attack any cancer or leukaemia cells that have survived.

The effects of GvHD are usually mild, but in some people they can be severe. You’ll be given drugs to prevent GvHD, or make it less severe if it happens. These are called immunosuppressive drugs and they work by weakening the immune system.

Acute GvHD usually happens within the first three months after a transplant. In some cases, it develops later. Acute GvHD is more likely to affect you if you have had total body irradiation, your donor is not a close match, or you haven’t taken your immunosuppressant drugs. Chronic GvHD may happen more than 100 days after transplant.

Symptoms of GvHD will depend on which parts of the body are affected. You will be given treatment and support to manage any GvHD symptoms.

Graft-versus-host disease (GvHD)

After a donor stem cell transplant, there’s a possibility that the new cells (the graft) will react against your own cells (the host).

This reaction is called graft-versus-host disease (GvHD). It happens when the donor immune system attacks your body tissues.

Occasionally, the donor’s stem cells may be treated with antibodies before the transplant. This is to remove white blood cells called T-lymphocytes that doctors think cause 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.

Graft-versus-host disease doesn’t mean that the transplant has failed. It can even have benefits, as the donor cells may attack any cancer or leukaemia cells that have survived.

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. It may affect one part of the body or several. The first signs can happen up to six months after your transplant.

In the past, GvHD that occurred within 100 days of transplant was called acute GvHD. If it happened more than 100 days after transplant, it was called chronic GvHD. But with reduced-intensity conditioning treatment, acute GvHD can now happen after 100 days as well. A treatment called donor lymphocyte infusions (DLI) can be given after day 100 and can also cause acute GvHD symptoms.


Immunosuppressive drugs

You’ll be prescribed drugs to help prevent or reduce GvHD.

These drugs are called immunosuppressive drugs and work by weakening the immune system. You will continue to take them when you go home from hospital. There are a number of different drugs that can be used:

  • 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 capsules.

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


Acute graft-versus-host disease

This is most likely to happen in the first three months after transplant, but it may develop later.

Acute GvHD is more likely to affect you if:

  • you have had total body irradiation (TBI) as part of your conditioning
  • the donor is not related to you or is not a close match
  • you haven’t taken your immunosuppressive drugs.

The symptoms of acute GvHD depend on which part of your body is affected. It often causes an itchy skin rash. If your bowel, stomach or liver are affected, you may have sickness and diarrhoea, and your skin or the whites of your eyes may become yellow (jaundiced).

Acute GvHD is usually graded by how severe it is:

  • Grade 1 is mild
  • Grade 2 has moderate symptoms
  • Grade 3 has severe symptoms
  • Grade 4 is very severe.

Grade 1 acute GvHD may not need treatment or you may be given steroid creams for your skin. If you develop Grade 2 acute GvHD 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

Chronic GvHD may happen more than 100 days after the transplant. It can develop after acute GvHD, or it can happen even if you haven’t had acute GvHD. Any symptoms will depend on which parts of the body are affected. They may include:

  • skin problems including dryness, flaking and ulcers
  • feeling short of breath or wheezy
  • a dry and swollen mouth and mouth ulcers
  • dry, gritty eyes
  • diarrhoea, stomach cramps, sickness and loss of appetite
  • repeated infections
  • muscle weakness and joint pain
  • vaginal narrowing and dryness.

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.


Other treatments for GvHD

Anti-thymocyte globulins (ATGs)

White blood cells called T-lymphocytes can affect normal blood cell production. Sometimes in acute GvHD, anti-thymocyte globulins (ATGs) are given. These make T-lymphocytes less active. This helps the bone marrow to make new blood cells. ATG is given as a drip through a vein. It is given in hospital because it can sometimes cause an allergic reaction. This treatment is not suitable for everyone.

Extracorporeal photopheresis (ECP)

In ECP, your blood cells are treated outside your body with special light treatment.

Two lumens of your central or PICC line will be connected by tubing to a cell separator machine. Blood goes down one line of tubing from your body into the machine. The blood is treated with ultraviolet (UV) light and drugs that become active when exposed to light. The treated blood is then returned to you by the other tube. The treatment continues until all of your blood has been treated by passing through the machine. This treatment is normally given two days in a row every 2–4 weeks.

The way ECP works in the treatment of GvHD is not fully understood. Researchers have shown that it alters the immune system without weakening it. It is used more for chronic GvHD and up to three quarters (75%) of people with GvHD will see an improvement in their symptoms. Your doctor or nurse will give you more information about the treatment. It is only available in some specialist centres.


Back to Side effects of allogeneic (donor) stem cell transplants