Nutrition and graft versus host disease

Graft versus host disease (GVHD) is a common complication that can occur after a person undergoes a medical procedure called an allogeneic stem cell transplant.

Also known as an allogeneic bone marrow transplant, this procedure is used to treat cancers that affect the bone marrow and blood cells, such as certain types of leukemia and lymphoma. It is also used to treat certain blood disorders and immune system disorders.

GVHD occurs when the white blood cells produced by the transplanted stem cells begin to attack healthy tissues throughout the body. The skin is the most common part of the body affected, but GVHD can also affect the liver, the GI tract, the eyes, muscles, lungs, and many other organs. Symptoms vary depending on whether a person has acute or chronic GVHD.

Drugs that suppress the immune system are the main therapy for GVHD. In addition to medications, nutrition can also play an important role in treatment.

Why nutrition is important to recovery

If you or a loved one is living with GVHD, you may already be well aware of the ways that the condition can affect a person's nutrition:

• GVHD that affects the gastrointestinal tract can cause diarrhea, vomiting, abdominal pain, nausea, loss of appetite, and unintended weight loss. Certain foods can make these symptoms worse or may be difficult to tolerate.
• A person's caloric intake and nutritional needs are greatly increased after an allogeneic stem cell transplant.
• GVHD can make it difficult to consume enough food and absorb nutrients—at a time when your body needs a greater supply of nutrients. People who have GVHD are at risk for nutritional deficiencies and malnutrition.
• People can also have difficulty eating after an allogeneic stem cell transplant. Dry or sore mouth, changes in how food tastes, and nausea are common.

Work with a registered dietitian

One of the best ways to ensure that you are getting adequate nutrition is to work with a registered dietitian. Also called a clinical dietitian, a registered dietitian is a healthcare provider who has licensing and accreditation to provide medical nutrition therapy.

Medical nutrition therapy is a branch of healthcare that focuses on using food and nutrition to manage, treat, and recover from health conditions. Your healthcare team may already include a registered dietitian, or your healthcare providers can refer you to one.

How a registered dietitian can help

GVHD is a different experience for every person. Likewise, treatment is different for everyone. A registered dietitian will help build an eating and nutrition plan based around your needs. This may include:

• Identifying your specific nutritional needs and building an individualized nutrition plan based on those needs.
• Recommending specific foods and/or changes to your diet. These kinds of changes should always be done under the guidance of a healthcare provider.
• Providing information and education on food safety—including proper food handling and preparation to avoid food-borne illnesses.
• Working with you to find ways to make eating more comfortable—and enjoyable. This may include strategies like smaller, more frequent meals or eating foods with higher protein and calorie content.
• Answering questions you have about the ways that GVHD impacts nutrition, and the ways that good nutrition can have an impact on GVHD.
• Assessing your risk of malnutrition or other complications.
• Coordinating with the other members of your healthcare team.

Keeping a journal of your symptoms, how you feel, and what you eat day to day can provide useful information for your healthcare providers.