Long-Term Follow-Up

Understanding graft-vs.-host disease

Q: What is graft-vs.-host disease (GVHD)?

A: GVHD results from an immune reaction after a marrow or blood cell transplant. Immune cells in the graft from the donor recognize body tissues in the patient or host as “foreign.”

The resulting immune response is similar to the reaction against an infection. GVHD can vary in severity, and different parts of the body can be affected. In severe cases, uncontrolled GVHD can be fatal. See:

GVHD: A Guide for Patients and Families After Stem Cell Transplant

Q: What is the difference between acute and chronic GVHD?

A: Acute and chronic GVHD are caused by different mechanisms within the immune system.

For this reason, the two forms of GVHD respond differently to treatment. Acute GVHD usually begins during the first 100 days after a transplant, although it can begin later.

Acute GVHD affects the skin, stomach, intestines and liver. Chronic GVHD usually begins more than 100 days after a transplant. Chronic GVHD can affect the same organs that are affected by acute GVHD.

Chronic GVHD also can affect connective tissue in the skin and joints, the mouth, esophagus and lungs, the glands that make saliva, the glands that make tears, and the vagina. See:

Graft-versus-host disease (wikipedia)

Q: Does GVHD cause permanent damage?

A: Chronic GVHD can cause permanent damage to tissues in the skin, connective tissue, glands and organs.

This damage can result in a number of problems such as permanently impaired lung function, permanent stiffening of skin and joints, or obstruction of the esophagus or vagina.

When glands are damaged, production of saliva or tears can be seriously impaired, resulting in damage in the mouth and eyes.

In addition, the changes of chronic GVHD can increase the risk cancer of the skin and mouth.

Q: Why is it important to carefully follow a chronic GVHD treatment plan?

A: Treatment of GVHD is designed to control the immediate symptoms and prevent long-term damage that can result from chronic GVHD.

Doctors carefully determine which medications and dosages are appropriate for each situation.

Dosages of these medications are slowly decreased over time in a way that allows the new immune system to adjust at its own pace.

Sometimes it is necessary to increase the doses or to change medications. GVHD can come back if treatment is stopped too soon. Half of the patients with chronic GVHD can complete their treatment within two to four years after starting. In other patients, it takes a longer time to complete the treatment.

Q: In what circumstances would a patient not receive treatment for GVHD?

A: In some cases the symptoms of chronic GVHD can be controlled by topical treatments such as skin creams, eye drops or swallowed topical medications to treat the stomach and small intestine.

The systemic medications used to treat chronic GVHD are powerful and can cause many side effects. These side effects can be avoided if the disease can be controlled without using these medications. See:

First-Line and Topical Treatment of Chronic GVHD

Q: What should I do if I think I am having new symptoms of GVHD?

A: Patients who have new symptoms or signs should contact their doctor if they had a transplant within the past year or if they are still taking medications that suppress the immune system (for example, prednisone, cyclosporine, tacrolimus, mycophenolate mofetil).

LTFU is available to assist patients and their doctors with any questions about symptoms or treatment related to GVHD.

Patients who are concerned about GVHD but had a transplant more than a year ago or are not taking immunosuppressive medications can call Long-Term Follow-Up (LTFU) at 206-667-4415.