Graft Versus Host Disease
Graft-versus-host disease (GVHD) is a complication of bone marrow transplants in which T cells in the donor bone marrow graft go on the offensive and attack the host’s tissues. GVHD is seen most often in cases where the blood marrow donor is unrelated to the patient or when the donor is related to the patient but not a perfect match. There are two forms of GVHD: an early form called acute GVHD that occurs soon after the transplant when the white cells are on the rise and a late form called chronic GVHD. Acute GVHD typically occurs within the first three months after a transplant and can affect the skin, liver, stomach, and/or intestines. The earliest sign is usually a rash on the hand, feet, and face which may spread and look like a sunburn. Severe problems with acute GVHD may include blisters on the skin, watery or bloody diarrhea with cramping, and jaundice (yellowing of the skin and eyes) reflecting liver involvement. Chronic GVHD typically occurs 2-3 months after the transplant and causes symptoms similar to those of autoimmune disorders such as lupus and scleroderma. Patients develop a dry, itchy rash which is raised like alligator skin. There also may be hair loss, decrease in sweating in the skin, and premature greying of the hair. Mouth dryness is a common symptom. It may progress to food sensitivity and spicy and acid food may sting. The eyes may also be involved with dryness and feel irritated and become red. Almost any organ can be affected by chronic GVHD. Prevention of severe GVHD includes elutriation (T-cell depletion), a technique in which the donor bone marrow is largely depleted of the T-cells that cause GVHD. Most patients also receive immunosuppressive drugs such as cyclosporine and methotrexate. Significant GVHD is usually treated with steroids and sometimes a drug called anti-thymocyte globulin.