Graft Versus Host Disease (GvHD)
If your child has received an allogeneic transplant, then he/she could develop graft-versus-host disease (GVHD). This side effect occurs in about 50% of the patients. The appearance of GVHD may coincide with the new stem cells engrafting and start to produce new white blood cells. GVHD is not caused by the stem cells, but by “passenger” lymphocytes that are infused with the stem cells. The lymphocytes may react to the tissues of their new host because the host tissues are seen as “foreign” so the donor lymphocytes “attack” the host in response. Patient organs that experience this initial attack, or GVHD, are usually on large surface organs of the patient such as the skin, liver and gut. One or all of these organs may be involved. Common signs of GVHD include skin rash, often starting on the palms of the hands or soles of the feet, diarrhea, jaundice (a yellow skin color) and abnormal liver function tests. Members of the SCT team are constantly watching your child for any of these signs. Medicines are given to prevent GVHD and other medicines may be added to control these symptoms if they occur.
Usually GVHD is mild but it can be severe. Severe GVHD requires aggressive treatment. If uncontrolled, GVHD can be fatal. We will treat your child with different medicines that will reduce the GVHD risk until new stem cells grow normally in your child.
Types and manifestations of GVHD
GVHD can take two forms, acute and chronic.
- Acute GVHD usually occurs during the first three months after transplant. A person may develop acute GVHD that goes away when treated or the acute GVHD may become chronic GVHD.
- Chronic GVHD usually develops three to 18 months after the transplant and can occur even if your child did not have acute GVHD.
Patients who get acute GVHD have a 50 percent chance of developing chronic GVHD. Chronic GVHD often affect the:
- Eyes. causing conjunctivitis, dryness and irritation, itching
- Skin. causing rash and itching
- Liver. causing jaundice and/or hepatitis
- Stomach and intestinal tract. resulting in loss of appetite, cramping pain, diarrhea, dry mouth and vomiting
Sometimes other organs of the body, including the lungs and kidneys, also are affected. A biopsy of the affected organ is often needed to confirm the diagnosis.
Prevention and treatment
There are several medicines that are used to help prevent, treat and reduce the severity of GVHD. Some of the medicines used include Cyclosporine or Tacrolimus, prednisone, and Methotrexate. Cyclosporine or Tacrolimus, is started two days before the transplant and continued for several months after transplant. These medicines may be given alone or in combination depending upon the type of transplant and the disease being treated by the transplant. The medicine levels of cyclosporine or tacrolimus are checked frequently to assist in maintaining safe and therapeutic doses.