Graft-versus-host disease and mental health

Graft-versus-host disease (GVHD) is a common complication that occurs after a procedure called an allogenic stem cell transplant (allogenic SCT). This procedure is used to treat many different conditions, including certain types of lymphoma and leukemia.

An allogenic SCT involves stripping away a person’s existing stem cells (typically using chemotherapy and radiation therapy) and then introducing new stem cells that come from a donor (ideally a close relative, but also a person that is a close genetic match). These new stem cells will begin making new white blood cells.

GVHD occurs when these new white blood cells begin attacking tissues and organs in the body. This can lead to numerous symptoms that affect the skin, the liver, the lungs, and many other areas of the body.

In addition to the physical symptoms, GVHD can also impact a person’s mood, emotions, and mental health. A significant percentage of people with chronic GVHD experience depression and anxiety. Psychological distress also makes the treatment of GVHD more challenging.

Here, we look at the relationship between allogenic stem cell transplants, GVHD, and mental health, and why people with GVHD need to prioritize mental health.

Stem cell transplants and mental health

Even without GVHD, undergoing an allogenic SCT can affect a person’s health and wellbeing in many ways:

• They may find they are tired all the time, have recurring colds, are undernourished, feel self-conscious about their appearance, and struggle with the change in the quality of their life.
• They may struggle with relationships, including friendship, intimacy, and feeling like a burden to their caregivers.
• They may find it difficult to cope with returning to normal activities, the uncertainty of whether a disease will recur, and financial distress over medical bills.
• They may have intrusive thoughts, feelings of emotional detachment or numbness, anxiety in medical settings, or other symptoms of post-traumatic stress.

The medications a person will need to take after an allogenic SCT can also contribute to these mental and emotional burdens. Corticosteroids and immunosuppressive drugs are a standard of follow-up care. These medications help regulate immune system activity as the body adjusts to the donor stem cells. They also cause side effects in some people, including mood swings, insomnia, and depression.

GVHD and inflammation

Inflammation is a key feature of GVHD and there is some evidence that GVHD causes inflammation in the central nervous system (the brain and spinal cord). Though the relationship is not fully understood, other research has shown an association between inflammation and several mental health disorders, including depression, anxiety, and post-traumatic stress disorder.

Mental health and treating GVHD

As mentioned above, one of the most challenging aspects of GVHD is the fact that it occurs after a person has already been through a serious illness and an aggressive treatment—a time when many are feeling physically, mentally, and emotionally vulnerable.

However, there is an upside to this—having gone through treatment, you already have a care team in place. Keeping all follow-up appointments with your healthcare team is essential after an allogenic SCT. These follow-up appointments will help identify problems like GVHD as early as possible—and prescribe appropriate treatment as early as possible.

Mental health should also be a focus of treatment, and something that you regularly discuss with your healthcare team during follow-up care. Here are some strategies and things to keep in mind that can help you prioritize your mental health:

• Be honest. Your appointments are a time to identify what you need from your healthcare providers. While you may want to put your best face forward, being honest about your moods, emotions, and concerns gives your healthcare providers information they need to provide you with better care.
• Work with a mental health professional. You may have a counselor or therapist on your healthcare team already. Counseling and therapy can help address the challenges of living with GVHD. If needed, your healthcare team can refer you to a psychiatrist, a healthcare provider who can prescribe medications to address mental health disorders like anxiety or depression.
• Schedule time for yourself. While it’s important to stay on top of your treatment, it is also important to take a break from treatment. Schedule some time each day to put everything aside and do something that you enjoy—read a book, play a game, take a walk, play with a pet. Make time for the important people in your life. You may also consider a stress-reducing activity such as meditation.
• Connect with others. If you aren’t already, consider participating in a support group for people who have undergone a stem cell transplant. While everyone’s experience is at least a little different, this will be an opportunity to talk to others who have had similar experiences.