Acute GVHD typically occurs during the first three months after transplant, although it can also occur later, often when immunosuppressive medicines are being tapered down.
Factors that may increase the risk of developing acute GVHD include:
- total body irradiation as part of the conditioning regimen before transplant
- advanced patient and donor age
- how well the patient and donor are matched
Prevention
To reduce the risk of developing acute GVHD, patients are usually given medications starting a day or two before transplant, or shortly thereafter, such as:
- cyclosporine
- tacrolimus
- methotrexate
- mycophenolate mofetil
- sirolimus
- antithymocyte globulin
- abatacept
These drugs suppress the donor's immune system that has been transplanted into you, making it more difficult for the donor's cells to attack your organs and tissues. You may need to continue taking these drugs for several months after transplant, and, in some cases, for life.
Recently, doctors have found that giving patients a chemotherapy drug called cyclophosphamide (Cytoxan®) a few days after transplant significantly reduces the incidence of both acute and chronic GVHD. This strategy is increasingly being used at many transplant centers..
At some transplant centers, the T-cells that cause GVHD are removed from the donor's cells prior to transplant. This procedure is called T-cell depletion.
Although T-cell depletion reduces the risk of developing GVHD, it can increase the risk of relapse or infection in some patients. Researchers are exploring whether removing a subset of T-cells from the donor's cells will protect patients against GVHD without increasing the risk of relapse or infection.
T-cells are a type of white blood cell. They are part of the immune system and develop from stem cells in the bone marrow. T-cells help protect the body from infection and may help fight cancer but can also cause GVHD.
Symptoms of Acute GVHD
Skin is often affected by acute GVHD. It may start as a faint rash that can be itchy. The rash may appear on the:
- back, shoulders, ears, or neck
- chest or abdomen
- legs or arms
- palms of the hands or soles of the feet
It typically resembles a heat rash, but in severe forms, it may look like a sunburn with blisters. The rash usually starts on a small area of skin and often spreads to more areas.
Acute GVHD can also affect the gastrointestinal tract, causing:
- persistent nausea and/or vomiting
- loss of appetite or feeling full after eating only a little food
- abdominal pain and cramping
- watery or bloody diarrhea
Sometimes acute GVHD affects the liver, causing:
- elevated liver enzyme levels
- jaundice (yellowing of skin and eyes)
- dark urine
Tell your doctor immediately if you develop any of symptoms of GVHD. Although these symptoms may be caused by other health problems, early detection and treatment of acute GVHD is important to prevent additional, serious complications.
Treatment
If you develop acute GVHD, steroids, such as prednisone or methylprednisolone, may help control the disease.
If your GVHD does not respond to these drugs, your doctor may try other treatments such as:
- ruxolitinib
- antithymocyte globulin
- sirolimus
- mycophenolate mofetil
- extracorporeal photopheresis
Extracorporeal photopheresis (ECP) is a procedure that removes some white blood cells from the patient, mixes them with a drug called psoralen and exposes them to ultraviolet light. The cells are then re-infused into the patient.
Once it appears that your acute GVHD is under control, your doctor will start tapering down the dosage of steroids or other drugs. It’s possible, however, for acute GVHD to return or get worse during the tapering process. You may need to continue the medication longer until the disease is no longer active.
Your doctor may also recommend that you enroll in a clinical trial that is testing a new therapy for acute GVHD.
Watch a video about extracorporeal photopheresis.
(To view this page in Spanish click here)
Next Page: Chronic Graft-versus-Host Disease
Updated December 2024
