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Graft-versus-host disease

What is graft versushost disease?

Graft versus host disease (GVHD) is a condition in which transplant the donor immune cells at transplant (graft) make antibodies against the tissues of the patient (host) and attacks vital organs. The most affected organs include the skin, gastrointestinal (GI) tract, and liver.

Ninety percent of bone marrow transplants lead to GVHD. Solid Organ transplantation, blood transfusions, and maternal-fetal transfusions have also been reported to cause GVHD less frequently.

Types of graft versus host disease

There are two forms of GVHD.

  • Acute GVHD

    • An early form of GVHD that occurs within the first three months of transplant
    • First sign It is generally a skin eruption appearing on the hands, feet and face
    • Gastrointestinal and liver dysfunction symptoms may continue
  • Chronic GVHD

    • The late form of GVHD that develops three months after transplant
    • It usually evolves from acute GVHD, but occurs de novo in 20-30% of patients
    • Cutaneous The (skin) reactions resemble those of autoimmune disorders such as lupus, lichen planus and especially systemic sclerosis

What are the signs and symptoms of graft versus host disease?

Acute GVHD and chronic GVHD are different diseases. A common factor is that both increase the patient's susceptibility to infection.

Acute GVHD chronic GVHD
  • Tender, red spots usually appear 10-30 days after transplant
  • Face, hands and feet affected first and then spreading to the entire body (erythroderma)
  • Nail may be lost or develop Beau lines
  • Stains can get together to form extended red rash
  • The rash may develop into raised spots or blisters that look like toxic epidermal necrolysis
  • Fever may be present
  • Watery or bloody diarrhea with stomach cramps indicates gastrointestinal involvement
  • Jaundice (yellowing of the skin and eyes) indicates liver involvement
  • Abnormal liver function tests.
  • A dry, itchy rash develops over the entire body (erythroderma)
  • Dry mouth and sensitivity to spicy or acidic foods that cause lesions in the mouth.
  • Dry eyes causing irritation and redness.
  • skin thickening, climbing, hyper or hypopigmentation (similar to lichen planus)
  • Loss of skin color without thickening (vitiligo)
  • Hardening of the skin (scleroderma) can interfere with joint mobility
  • Hair loss (including typical alopecia areata) or premature gray hair
  • A dystrophy
  • Genital disease, including painful vulva and vaginal. ulceration with scars
  • Decreased sweating
  • Liver involvement causing jaundice
  • Lung and gastrointestinal disorders may occur.

How is graft versus host disease diagnosed?

Graft-versus-graft disease may be suspected in patients who have received a transplant and develop cutaneous or systemic complications. Must be confirmed by tissue biopsy. See graft versus host disease pathology for the skin histological features.

What is the treatment of graft versus host disease?

Patients who recover from bone marrow transplant are usually hospitalized for several weeks after the transplant and are closely monitored for signs of GVHD or infection. The best treatment for GVHD is prevention. This consists of a cocktail of immunosuppressive medications such as:

  • Cyclosporine
  • Methotrexate
  • Cyclophosphamide
  • Mycophenolate
  • Tacrolimus
  • Sirolimus

  • Prednisone

The combination of cyclosporine and methotrexate has been found to significantly decrease the severity of GVHD. These drugs weaken the ability of the donor's immune cells to launch an attack against the patient's organs.

Treatment for patients who develop GVHD depends on the severity of the disease. Mild cases with only skin involvement of acute GVHD may resolve without treatment. More severe acute or chronic GVHD predisposes the patient to infection and is overwhelming. septicemia (blood poisoning) is the leading cause of death in patients with GVHD. The goal is to treat GVHD before life-threatening sepsis occurs.

  • Local skin care should include emollients and current steroids
  • the vulvovaginal The disease should also be managed using estrogen cream, intravaginal corticosteroids or tacrolimus and dilators.
  • High doses of corticosteroids are usually added to the immunosuppressive regimen.
  • Managed monoclonal Antibodies like rituximab seem very effective but are very expensive.
  • In 2019, rUxolitinib was approved by the Food and Drug Administration (FDA) in the US for the treatment of steroid-resistant GVHD in adults and children over 12 years of age.

  • Photochemotherapy (PUVA) and high doses of long wave Ultraviolet radiation (UVA1) can reduce the severity of skin problems.

  • Extracorporeal photopheresis is available in some centers and can be very effective.

Because GVHD affects so many different organs, treatment is usually administered by a multidisciplinary team of transplant doctors, dermatologists, respiratory doctors, gastroenterologists, ophthalmologists, and other specialists.