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Graft vs Host Disease


About this topic


Graft versus host disease is also called GVHD. It is a problem that may happen after a stem cell or bone marrow transplant. GVHD is when the transplant or graft cells think the normal or host cells are foreign and attack them. This happens more when the transplant comes from a donor who is not related. Graft versus host disease can happen right away or a long time after transplant. It can affect many body systems, like your skin, liver, eyes, lungs, or stomach and bowels. ‚  

What are the causes?


The immune system is our tool to protect us from infection and diseases. When you have a stem cell or bone marrow transplant, the new cells are the graft or donor cells. They are supposed to build a new immune system in you, the host. Sometimes your donor cells think your body is foreign and attack it. This harms your body in many ways. ‚  

What can make this more likely to happen?


  • GVHD is more likely to happen when the donor cells come from some other person. You do not get GVHD if your own cells are given back to you.
  • The closer the donor cells match your cells, the less likely you are to get GVHD. Donor cells from a twin or family member will give you a lower chance of GVHD.

What are the main signs?


GVHD can be either acute or chronic. Both may be mild or life threatening. You may have one, the other, or both kinds of GVHD. Some people do not have GVHD at all. ‚  
  • Acute GVHD
    • Most often happens in the first 100 days after transplant
    • May start with a rash and burning and redness on the palms of hands and soles of feet
    • Other signs may include upset stomach and throwing up, loose stools that may be bloody, belly pain, loss of appetite, and weight loss
  • Chronic GVHD
    • Most often starts 100 to 400 days after transplant
    • May start with a rash on palms of hands and soles of feet. Rash may itch and spread and your skin may blister and peel.
    • Skin may darken in color and may become tough or hard
    • Hand joints may not move as well because of hardened skin over joints
    • Other signs may include loose stools, belly pain, loss of appetite and weight loss, liver problems, yellow skin and eyes, decreased moisture in eyes or vagina, sores in the mouth, infections, and problems with your lungs

How does the doctor diagnose this health problem?


Your doctor will take your history and do a physical exam. Talk to the doctor about: ‚  
  • All the drugs you are taking. Be sure to include all prescription and over-the-counter drugs, and herbal supplements. Tell the doctor if you have any drug allergy. Bring a list of drugs you take with you.
  • Any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin, ibuprofen, Aleve (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding. You may need to stop these drugs as well. Talk to your doctor about them.
  • Any problems you are having, such as pain, rashes, and loose stools

Your doctor may order: ‚  
  • Lab tests
  • X-rays
  • Skin biopsy

How does the doctor treat this health problem?


Both acute and chronic GVHD are treated with steroids or drugs to lower the effects of your immune system. Your doctor may also give you other drugs to treat your signs. ‚  

Will there be any other care needed?


You are at a high risk for an infection after a transplant. Talk with your doctor about specific things you should do to prevent infections. Here are some general things you can do to help keep yourself healthy. ‚  
  • Wash your hands often with soap and water for at least 15 seconds, especially after coughing or sneezing. Alcohol based hand sanitizers also work to kill germs.
  • If you are sick, cover your mouth and nose with tissue when you cough or sneeze. Throw away tissues in the trash and wash your hands after touching used tissues. You can also cough into your elbow.
  • Avoid getting too close (kissing, hugging) to people who are sick.
  • Avoid sharing personal items. Use disinfectant to clean things like door handles, remotes, toys, and phones.
  • Avoid going to crowded places like shopping centers or grocery stores.
  • Get a flu shot each year.
  • Avoid the sun.
  • Wear clothes that will cover your arms and legs if you must go out when it is sunny.
  • Use at least SPF 30 sunscreen on exposed skin.

Where can I learn more?


Be the Match ‚  
http://bethematch.org/For-Patients-and-Families/Life-after-transplant/Graft-versus-host-disease-(GVHD)/ ‚  
Clinical Center National Institutes of Health ‚  
http://www.cc.nih.gov/ccc/patient_education/pepubs/gvh.pdf ‚  
Leukemia and Lymphoma Society ‚  
http://www.lls.org/diseaseinformation/managingyourcancer/treatmentnextsteps/typesoftreatment/stemcelltransplantation/graftvshostdisease/ ‚  

Consumer Information Use and Disclaimer


This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care providers advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you. ‚  

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