Graft-Versus-Host Disease

Synonyms

GVHD,

Overview

Graft-Versus-Host Disease (GVHD) is a complication of allogeneic stem cell transplantation where the donor’s immune cells (the graft) attack the recipient’s body (the host) because they recognize the host’s cells as foreign. It can be categorized as acute, appearing within months and affecting the skin, liver, and gut, or chronic, developing later and causing long-term damage to various organs like the eyes, skin, and lungs. While treatments like immunosuppressive medication and close monitoring are used to prevent or manage GVHD, it remains a serious risk for recipients of stem cell transplants.

Symptoms

Graft-Versus-Host Disease (GVHD) symptoms depend on whether it is acute or chronic, but common signs include skin rashes, itching, and dryness; gastrointestinal issues like nausea, vomiting, and diarrhea; and liver problems, which can lead to jaundice. Chronic GVHD can also cause chronic dry eyes and mouth, joint pain, muscle weakness, and lung damage.

Causes

Graft-Versus-Host Disease (GVHD) is caused by donor T-cells attacking the recipient’s body in an allogeneic stem cell or bone marrow transplant. The donor cells recognize the patient’s tissues as foreign due to differences in their human leukocyte antigens (HLA) and mount an immune response, leading to damage in organs like the skin, liver, and intestines. Risk factors include a poor HLA match between the donor and recipient, a non-related donor, and certain conditioning treatments before the transplant.

Prevention

Graft-Versus-Host Disease (GVHD) prevention involves suppressing the donor’s immune cells (T-cells) using immunosuppressive drugs like tacrolimus (or cyclosporine) with methotrexate, or newer triple-drug regimens with cyclophosphamide and mycophenolate mofetil. T-cell depletion before or during the transplant can also be used. Post-transplant, continued medication, sun protection, and immediate reporting of GVHD symptoms are crucial for prevention and early treatment, with treatment options evolving to improve outcomes and reduce side effect.

Diagnosis

Graft-Versus-Host Disease (GVHD) diagnosis combines clinical evaluation of signs and symptoms with various tests, including laboratory studies, imaging (like CT scans, X-rays, and MRIs), and biopsies of affected tissues such as skin or liver, depending on the organ involved and whether acute or chronic GVHD is suspected. Chronic GVHD is primarily a clinical diagnosis defined by specific clinical criteria across a range of organs, while acute GVHD relies heavily on biopsy findings to confirm the diagnosis.

Prognosis

Graft-Versus-Host Disease (GVHD) prognosis varies significantly based on severity and organ involvement, with mild cases often responding well to treatment while severe or life-threatening forms carry a high risk of mortality. Factors like severity grade, the presence of extensive skin or organ involvement (especially liver and GI tract), and specific biomarkers such as bilirubin levels can predict poor outcomes

Treatment

Graft-Versus-Host Disease (GVHD) treatment involves immunosuppressive medications like steroids (prednisone), calcineurin inhibitors (tacrolimus, cyclosporine), and purine analogs (mycophenolate mofetil), which prevent the new immune cells from attacking the recipient’s body. If these treatments aren’t enough, extracorporeal photopheresis (ECP), a special type of light therapy, or additional drugs such as ruxolitinib or belumosudil may be used. The treatment approach depends on whether the GVHD is acute or chronic and the organs affected, with treatment starting early for better outcomes.