Graft-Versus-Host Disease (GVHD)

 GVHD Overview & Treatment

Graft-versus-host disease (GVHD) is a medical condition that can occur after a stem cell or bone marrow transplant. It is a complication where the donor's immune cells recognize the recipient's body as foreign and attack the recipient's tissues. GVHD is more commonly associated with allogeneic transplants, where the donor and recipient are not genetically identical.

GVHD typically occurs in two forms: acute and chronic. Acute GVHD usually develops within the first few months after transplantation and can affect the skin, gastrointestinal tract, and liver. It may cause symptoms such as skin rash, diarrhea, nausea, abdominal pain, and jaundice. Chronic GVHD generally occurs several months after the transplant and can persist for a long time. It can affect multiple organs, including the skin, mouth, eyes, liver, lungs, and joints. Symptoms of chronic GVHD vary but may include skin changes, dryness of mucous membranes, joint stiffness, fatigue, and weight loss.

The main cause of GVHD is the mismatch between the donor's immune cells and the recipient's tissues. When the donor's immune cells (graft) recognize the recipient's tissues (host) as foreign, they trigger an immune response, leading to inflammation and tissue damage. The extent and severity of GVHD can vary from mild to life-threatening.

To reduce the risk of GVHD, transplant centers perform HLA (human leukocyte antigen) matching between the donor and recipient. HLA matching involves matching specific proteins on the surface of immune cells to minimize the risk of the immune cells attacking the recipient's tissues. However, even with a good HLA match, GVHD can still occur.

The treatment of GVHD depends on its severity. Mild cases may be managed with corticosteroids to suppress the immune response. For more severe or chronic cases, additional immunosuppressive medications may be used, such as cyclosporine, tacrolimus, or sirolimus. In some cases, photopheresis or extracorporeal photopheresis (ECP) may be used, which involves removing the patient's blood, treating it with ultraviolet light, and returning it to the body. This process may help modulate the immune response.

Preventing GVHD remains an active area of research. Scientists are investigating various strategies, such as selective depletion of certain immune cell populations from the donor graft, the use of immunomodulatory drugs, and manipulating the immune system to promote tolerance and reduce the risk of GVHD.

If you or someone you know is experiencing symptoms or complications related to GVHD, it is important to consult with a healthcare professional or the transplant team for an accurate diagnosis and appropriate treatment.