What is Graft vs. Host Disease?
vs. Host Disease (GvHD) is a reaction that develops after an allogeneic bone marrow transplant. An allogeneic transplant
is one in which the donor is not the same person as the recipient. It is also
possible to have your own bone marrow cells harvested and transplanted back
into you, if you are scheduled to have a treatment that will damage them. This
is called an autologous bone marrow transplant.
marrow cells are a major component of the immune system. In GvHD, the
transplanted cells see the recipient’s
body as foreign. The grafted cells then attack their new host. This is how the
condition got its name.
is extremely common after bone marrow transplantation. However, it usually goes
away after the transplant has become well established in your body.
Types: Acute and Chronic GvHD
are two forms of graft vs. host disease: acute and chronic.
GvHD occurs within weeks of receiving a
bone marrow transplant. It is usually the result of the donor’s stem cells and bone marrow not matching the recipient’s. It is important for the human leukocyte antigen (HLA) in
both the donor and recipient to match. Otherwise, the donor’s bone marrow views the recipient’s cells as foreign and attacks them. Recipients who receive
mismatched bone marrow are at the highest risk of developing this condition.
However, GvHD can occur even with proper HLA matching.
GvHD normally affects the skin, liver, and gastrointestinal system.
GvHD develops over a longer course of time
than acute GvHD. Its underlying cause is the same as acute GvHD. However, the
reaction is less severe.
with chronic GvHD may not develop symptoms for several months. Sometimes,
symptoms do not show up for several years. Chronic GvHD can affect any area of
GvHD and Leukemia
most commonly occurs in patients with leukemia who have undergone a bone marrow
is a form of cancer that begins in the cells of the bone marrow. The bone
marrow is the sponge-like area of bone where blood cells are produced. In
patients with leukemia, the bone marrow grows uncontrollably. This leads to an
influx of white blood cells often with a reactive deficiency of red blood
cells. While many treatments exist, Leukemia can be a life-threatening
with certain forms of leukemia may require a bone marrow transplant when other
types of treatment fail. Types of leukemia that are treated with bone marrow
- acute lymphocytic leukemia (ALL)
- chronic myeloid leukemia (CML)
- acute myeloid leukemia (AML)
How Does GvHD Develop?
exact cause of GvHD isn’t always clear. However, researchers
agree that several risk factors increase the likelihood of GvHD. The biggest
risk factor for GvHD is an HLA mismatch between the recipient and donor. This
can cause both chronic and acute GvHD.
risk factors for acute GvHD include:
- age differences between the recipient and donor
- sex differences between recipient and donor
- receiving bone marrow from a woman who had been
pregnant within the previous year
primary risk factor for chronic GvHD is having a history of acute GvHD.
Signs of Graft vs. Host Disease
the bone marrow cells from the donor begin to attack the recipient’s cells, symptoms may occur in several of the body’s systems.
symptoms commonly affecting those with acute GvHD include:
- dark patches or darkening of the skin
- abdominal cramping
of the skin and eyes (jaundice)
you have recently had a bone marrow transplant and are experiencing any of these
issues, contact your doctor.
How Is GvHD Diagnosed?
you are a bone marrow transplant recipient with symptoms of GvHD, talk to your
doctor as soon as possible. During your visit, tell your doctor about all of
your symptoms, no matter how minor they may seem.
your doctor suspects you have GvHD, you will receive a blood test. This test
will look for high levels of white blood cells, which usually indicate an
your test shows a high white blood cell count, you may need a tissue biopsy.
The biopsy is usually performed while you are under sedation. It can also be
performed with just a local anesthetic. A small piece of tissue will be removed
from the area affected by GvHD. It will then be sent to the lab and tested for
many cases, a urinalysis (urine test) will also be used to detect signs of
infection. Urine tests can be used to rule out conditions such as diabetes or
What Treatment Options Are Available for
primary treatment for GvHD is prescription immunosuppressants. These drugs
reduce the immune response of the donor cells. They are usually prescribed in
the form of intravenous or oral steroids.
are often used to treat acute GvHD, along with the following medications:
are often prescribed to treat chronic GvHD, along with the following
Are There Ways to Prevent GvHD?
treatment with immunosuppressant medications may reduce the risk of GvHD after
transplantation. These drugs are usually started before the transplant. Your
doctor may recommend that you continue to take them for several months after the
transplant is complete.
a year after your bone marrow transplant, your body may enter a “state of tolerance.” At this point, immunosuppressive medications are less
one year, most recipients will have formed new T lymphocytes that match the
donor cells. These matching cells keep the donor marrow from attacking the
People who do not enter a state of tolerance may need
to continue taking immunosuppressants for a longer period of time.