Graft-versus-host disease: acute versus chronic

Graft-versus-host disease (GVHD) is a condition that affects some people who have undergone an allogenic stem cell transplant. Also known as a bone marrow transplant, and allogenic stem cell transplant is a procedure used to treat certain types of leukemias and lymphomas, as well as many other conditions.

During an allogenic stem cell transplant, a person receives stem cells from a donor. A donor is a biological relative or someone who has stem cells that are genetically similar to the recipient’s stem cells. These donor stem cells are used to replace diseased stem cells that have been destroyed with chemotherapy and radiation therapy.

The donor stem cells essentially form a new foundation for the recipient’s immune system and begin making new immune cells to defend the body against infections and harmful invaders. Unfortunately, these new immune cells may also attack healthy tissues and organs. When this occurs, a person has GVHD.

Here, we look at the different types of GVHD, how symptoms can vary in severity, and how GVHD can affect different areas of the body.

Treatment for GVHD will depend on the organs involved, the severity, and whether GVHD is acute or chronic or another type.

Types of GVHD

Traditionally, there have been two main types of GVHD, acute and chronic. In recent years, healthcare providers have begun to refer to these as classic acute GVHD and classic chronic GVHD, and have added additional subtypes.

• Classic acute GVHD. This type refers to cases of GVHD that occur within the first 100 days following a stem cell transplant. This type typically affects the skin, mouth, the gastrointestinal tract, and the liver. Skin rashes, GI symptoms (such as diarrhea and nausea), and jaundice (which causes a yellowing of the eyes and skin and indicates liver problems) are common symptoms.
• Classic chronic GVHD. This type refers to cases of GVHD that occur after the first 100 days. Classic chronic GVHD typically affects a wider range of sites in the body. It can cause changes and damage to the mouth, skin, hair, and nails. It can disrupt the functioning of the digestive system, liver, lungs, muscles, joints, and reproductive organs.
• Persistent, recurrent, late onset acute GVHD. This type presents with symptoms of acute GVHD, but it occurs after the 100-day period.
• Overlap syndrome. Symptoms of this type can begin at any time. As the name implies, there is an overlap of symptoms between the acute and chronic forms of GVHD.

In addition to categorizing GVHD as acute or chronic (or overlap syndrome), a healthcare team will also assign a stage (and for acute GVHD, a grade). There are separate scoring systems used for the different types, but both work by taking into account the number of organs involved as well as the severity of involvement.

Treatment

Treatment for GVHD will depend on the severity of symptoms, whether GVHD is acute or chronic, and the symptoms GVHD is causing:

• It may involve adjusting medications you are already taking, such as immunosuppressive drugs.
• It may also involve taking different medications, such as corticosteroids.
• Chronic GVHD may need to be treated with long-term immunosuppressants.
• Because the medications used to treat GVHD impact how the immune system functions, other medications may be prescribed to reduce the risk of infections.

Remember, GVHD is a different experience for each person. Your best source of information will be your healthcare team.