Graft-versus-Host Disease (GvHD)
Graft-versus-host disease is a reaction of the T-lymphocytes in the donor
marrow (the graft), against the recipient's body (the host). GvHD can be acute
or chronic. Acute GvHD occurs within the first 100 days following transplant.
Chronic GvHD is when symptoms start or continue past 100 days after transplant.
A patient who has acute GvHD is more likely to have chronic GvHD.
Who is at risk for GvHD?
- Patients who receive a mismatched transplant. (The greater the degree of
mismatch, the greater the risk of GvHD).
- Patients whose donor is female and has given birth.
- Older BMT patients.
What are the signs and symptoms of GvHD?
There are primarily three organs affected by GvHD: skin, liver and gut. Not
all organs may be involved in every patient.
- Skin: Starts as a faint, red rash on the palms of the hands and soles
of the feet, spreads to head, neck, chest, and extremities. Most severe forms
may cause the skin to blister and peel over the entire body surface.
- Liver: Increase in certain liver enzymes and bilirubin levels. The
liver may become enlarged and the patient may experience right-sided abdominal
pain.
- Gut: Diarrhea is the primary symptom. It may be frequent and in large
amounts, and may sometimes be positive for blood. Nausea, vomiting, and abdominal
pain are also possible.
If there is no skin rash, but there are liver and gut symptoms, then the cause
could also be an infection or a side effect of the chemotherapy or radiation.
A biopsy may be ordered by your doctor to help determine the exact cause of
the symptoms. This is important because the treatment for GvHD is different
than the treatment for infection or for side effects of therapy.
What is the treatment of GvHD?
Most patients who have a less than perfectly matched donor will receive anti-thymocyte
globulin (ATG), which is a medicine that suppresses the graft-versus-host reaction.
ATG can cause the platelet count to drop so it is not unusual to receive platelets
after receiving ATG. ATG is given every other day for two weeks, starting the
day before the transplant.
Intravenous steroids such as methylprednisolone are also used to suppress the
GvH reaction. Steroid creams may be helpful with a skin rash.
Cyclosporin may be prescribed by your doctor to control GvHD. This medicine,
in some patients, may cause liver or kidney damage. All patients are closely
monitored to insure they receive maximum benefit and minimal side effects from
the medications and treatments they receive.
Plaquenil is a new drug being used to treat resistant and severe acute and/or
chronic GvHD. If your doctor prescribes this, he will ask your permission to
enroll your child on a research study being performed here. Side effects of
plaquenil are quite minimal, but special visions tests will be performed while
on this study.
For a skin rash, it is helpful to use a mild soap when bathing. Lotions applied
two or three times a day will keep the skin from drying out. Try to avoid lotions
that contain alcohol as they can dry the skin even more. It may also help to
wear loose-fitting cotton clothing to decrease irritation.
If diarrhea is severe, dietary restrictions may be necessary. Milk tends to
increase the problem so milk and milk products may be restricted or eliminated
temporarily. Your doctor may also order a low-fiber diet to decrease mechanical
irritation to the gut. We can give intravenous feedings if needed so your child's
nutritional needs will be met.
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