Health Info #8

Graft-versus-Host Disease (GVHD)
GVHD is a common complication following an allogeneic stem cell transplant. Twenty to fifty percent of patients undergoing a stem cell transplant with a related HLA-matched donor develop GVHD. The incidence is higher among older patients and those transplanted with stem cells from an unrelated donor or HLA mismatched donor.

GVHD is triggered by cells called T-cells. T-cells are a type of white blood cell that can recognize which cells belong in the individual's body,and which cells do not. When a donor's T-cells are transplanted into a patient, they perceive the patient's organs and tissues as foreign cells, and orchestrate an immune system attack to destroy them.

GVHD is often discusses as if it were a single disease. It is, in fact, two diseases: acute GVHD and chronic GVHD. Patients may develop one, both or neither. Acute and chronic GVHD differ in their symptoms, clinical signs and time of onset.

Acute GVHD
Patients who develop acute GVHD usually do so during the first three months after transplant. The earliest sign is often a faint rash on the patient's chest or back. A skin rash may also appear on the patient's hands and feet. The rash may spread to other parts of the body and develop into a general redness, similar to a sunburn, with peeling or blistering skin.

Acute GVHD can also affect the stomach and intestines causing cramping, nausea and watery or bloody diarrhea. Jaundice may indicate that acute GVHD has affected the liver.

Physicians grade the severity of acute GVHD according to the number of organs involved and the degree to which they're affected. Acute GVHD may be mild, moderate or sever or life-threatening.

Prevention and Treatment of Acute GVHD
To reduce the risk of developing acute GVHD, patients are typically given a combo of cyclosporine and methotrexate, tacrolimus and methotrexate or cyclospring and mycophenolate mofetil.

Stages of acute GVHD
Stage 1 (mild); a skin rash over less than 25% of the body.
Stage2 (moderate): a skin rash over more than 25% of the body accompanied by mild liver, stomach and intestinal disorders.
Stage 3 (severe): redness of the skin, similar to a sunburn and moderate liver, stomach and intestinal problems.
Stage 4 (live-threatening): blistering, peeling skin and severe liver, stomach and intestinal problems.

Chronic GVHD
Chronic GVHD develops during or after the third month post-transplant. Patients with chronic GVHD usually experience skin problems that may include a dry itching rash, a change in skin color, and tautness or tightening of the skin. Liver abnormalities, dry or burning eyes, dry mouth, mouth sores, infections and stomach irritations are also common symptoms of chronic GVHD

Less frequently, patients experience skin scarring, partial hair loss, or premature graying of the hair. Others develop severe liver problems, vision difficulties, heartburn, stomach pain, difficutly swallowing, weight loss or breathing difficulties. Lung problems are a common complication of chronic GVHD. These can be serious and require prompt treatment.

patients who have had acute GVHD have the greatest risk of developing chronic GVHD. Older patients, those transplanted with stem cells from an unrelated or HLA mismatched donor, and those transplanted with stem cells that were collected from the bloodstream rather than with bone marrow may also have a greater risk of developing chronic GVHD.

Symptoms/side effects of chronic GVHD
Most common- rash, itching, general redness of skin, dark spots, tautness of skin, jaundice, abnormal liver tests, dry,burning eyes, dryness or sores in the mouth, burning sensation when eating acidic food, bacterial infection.
Less common- skin scarring, partial hair loss, premature graying, severe liver disease, vision impairment, heartburn, stomach pain, difficulty swallowing, weight loss, contractures, difficulty breathing, bronchitis, pneumonia.