Symptoms and Signs of Graft Versus Host Disease (GVHD)

Common Actue and Chronic Symptoms of GVHD

What are the symptoms of graft versus host disease (GVHD)?. Credit: Istockphoto.com/Stock Photo©robIan

What are the symptoms of graft versus host disease and how bad do they get?

Graft versus Host Disease Basics

Graft versus host disease (GVHD) is a common and occasionally serious complication of an allogeneic bone marrow or peripheral blood stem cell transplant for leukemias and lymphomas.  In an allogeneic transplant, donated cells are used from another person, whether a family member or an unknown donor.

Signs and Symptoms of Graft versus Host Disease (GVHD)

GVHD may occur within a few days of transplant to many months later. The signs and symptoms of this condition depend, to some extent, on when GVHD manifests itself. Based on when it occurs after the transplant, doctors often label GVHD as 'acute' or 'chronic.'

Symptoms of Acute Graft versus Host Disease (GVHD)

When GVHD occurs within 100 days of a bone marrow or stem cell transplant, it is called an ‘acute’ GVHD. The most common time of occurrence of symptoms of GVHD is between 2 to 6 weeks following the transplant.

Symptoms most commonly involve:

  • Skin - The most common symptom of GVHD is a skin rash.  The rash commonly affects the palms of the hands and the soles of the feet, but can affect skin essentially anywhere on your body.  This may vary from a little redness, to blisters, to peeling in which sections of skin basically slough off leaving redness and tenderness below.  For some reason transplant recipients often experience sun sensitivity in which sun exposure can both trigger GVHD as well as accentuate the skin symptoms of this disease.
  • Liver - When GVHD affects the liver, it's common for people to experience jaundice (a yellowish discoloration of the skin and whites of the eyes) as well as itching.
  • Intestines - Involvement of the intestines may result in cramping abdominal pain, diarrhea, and blood in the stools.

Symptoms of Chronic Graft versus Host Disease (GVHD)

Chronic GVHD develops more than 100 days after a transplant.

It is more likely to develop in those who show symptoms of acute GVHD, even though it can arise for the first time in patients who have had no signs of GVHD in the first 100 days. Although it may develop many months after a transplant, more than half the cases of chronic GVHD manifest within the first 6 to 8 months of transplant.  It's not known whether chronic GVHD is an extension of acute GVHD or if it is a separate condition altogether, perhaps some type of autoimmune condition.  Symptoms may include problems related to:

  • Skin - Redness, blistering, and peeling may occur as with acute GVHD, but people with chronic disease may also experience skin tightening and thickening along with more extensive discoloration.
  • Liver - Jaundice may occur as with acute GVHD.
  • Intestines - As with acute disease, symptoms such as diarrhea, abdominal cramps, and nausea and vomiting may occur.
  • Eyes - Dry, burning eyes are a common chronic symptom as the glands which produce tears dry up.
  • Mouth - The salivary glands may produce less saliva resulting in a dry mouth.
  • Genitals - Vaginal dryness can make intercourse very uncomfortable for women, who are also at risk of urinary tract infections related to the dryness.
  • Muscle and joints - Involvement of your muscles and joints can cause chronic pain, aching, and weakness
  • Overall - General fatigue in combination with pain and weakness can be profound.

The symptoms of graft versus host disease may be mild, or severe and disabling.  If you are suffering severe symptoms talk to your doctor.  Sometimes combining different modalities of treatment - such as including mind/body therapies and cognitive behavioral therapy  - "talk therapy" - can be helpful as you cope with these disabling symptoms.  These often occur at at time when cancer survivors are feeling a little at a loss to begin with - coping with that feeling of "I've survived - now what?"  Talk to your doctor about survivorship - how to return to living after the trauma of cancer and its late effects.

Treating Graft versus Host Disease

In addition to steroids (such as prednisone) there are many different medications that are used to treat graft versus host disease.

Sources:

Bayraktar, U., and J. Nates. Intensive care outcomes in adult hematopoietic stem cell transplantation patients. World Journal of Clinical Oncology. 2016. 7(1):98-105.

Chao, N. Clinical manifestations, diagnosis, and grading of acute-versus-graft disease. Updated 05/04/15. http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-grading-of-acute-graft-versus-host-disease

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