Strategies to avoid infection when treating GVHD

Drugs that suppress the immune system are the main treatment for graft versus host disease (GVHD). These medications can keep the immune system from attacking healthy tissues, but they also prevent the immune system from carrying out its normal functions—and people taking these medications will be at a higher risk of infections.

Here, we look at some basic strategies to prevent infection when living with GVHD. All of these strategies should be reviewed with your healthcare providers, who will always be your best source of information.

A disease of the immune system

GVHD is a common complication after an allogeneic stem cell transplant, also known as a bone marrow transplant. After transplantation, stem cells will mature into blood cells, including white blood cells.

White blood cells are part of the immune system. When these cells encounter something that doesn’t belong—such as a cell infected with a virus, damaged tissue, an irritant, or chemical—white blood cells go into attack mode. They start a chain of cellular-level events that remove the foreign substance from the body.

When white blood cells are transplanted into a new body, they are surrounded by foreign tissues they do not recognize. GVHD occurs when these immune cells start to attack surrounding tissues.

Immunosuppressants

After a person undergoes an allogeneic stem cell transplant, they will need to take immunosuppressive drugs. These are drugs that lower the body’s immune response and can help stop the immune system from damaging healthy tissue. They are also used to prevent the body from rejecting transplanted organs and to treat some autoimmune diseases.

Immunosuppressive drugs help prevent GVHD and are also used to treat GVHD if it occurs. Treatment for GVHD often involves taking oral corticosteroids—or medications called kinase inhibitors if corticosteroids are not effective or cannot be used for other reasons. These medications can be very helpful in managing the symptoms of GVHD but also reduce the body’s ability to fight infection.

Because GVHD is different for each person, treatment plans are individualized. One thing that every treatment plan will have in common—it will include strategies to avoid infection.

Strategies to avoid infection

To prevent infections, it’s helpful to keep in mind the basics of how infections occur. An infection occurs when a pathogen (a germ) enters the body and begins to grow, multiply, and spread. Viruses, bacteria, fungi, and yeast are all examples of pathogens that can cause infections.

Some basic strategies for preventing infections:

• Avoid touching your face, especially your eyes, nose, and mouth.
• Avoid crowded places and avoid people who are sick.
• Avoid sharing utensils, beverages, and food with others.
• Wash your hands regularly, using lukewarm water and soap. Wash for no more than 20 seconds each time and moisturize afterward to avoid drying out the skin. Skin rash and blisters are among the most common symptoms of GVHD, and moisturizing is important to managing these symptoms.
• Use hand sanitizer if you cannot wash your hands. Pack moisturizer along with hand sanitizer.
• Wear a mask if you are going out, especially if you are going to be in a crowded place.
• Follow proper food handling and preparation, such as washing produce and always cooking meat to the recommended internal temperature. Ask your healthcare providers for guidelines on foods to avoid and safe food handling and preparation.
• Make sure your healthcare providers know about all the medications you take, including medications for other conditions, over-the-counter medications, and any supplements.
• Stay up to date on vaccines. Your healthcare providers can review vaccines and boosters that they recommend.
• Talk to your healthcare providers about any travel plans. You’ll want to avoid traveling to places where there are outbreaks of infectious disease. You may need additional vaccinations when traveling internationally, depending on your destination.
• Talk to your healthcare providers about how to care for a wound or injury and prevent wounds and injuries from becoming infected.
• Have a plan in place in case you start to feel ill. Talk to your healthcare team about what symptoms to watch for, when to contact them, and when to seek emergency medical care.

Remember that everyone’s risk of infection is different. It’s important to discuss your risk with your healthcare providers. It’s also important to take your medications exactly as prescribed by your healthcare providers. Skipping doses or stopping a medication can lead to more severe GVHD symptoms and serious health complications.