What is the treatment for graft-versus-host disease?

If you or a loved one has had an allogenic stem cell transplant (allogenic SCT), follow-up care is extremely important. Also called a bone marrow transplant, an allogenic SCT is a procedure used to treat certain types of lymphomas and leukemias—blood cancers that begin in the bone marrow—and many other conditions.

The procedure involves destroying diseased cells in the bone marrow and replacing them with healthy cells from a matching donor. Donor cells begin making new blood cells, including white blood cells, which act as the body’s defense against infections and injury.

Unfortunately, complications can occur. One example is a condition called graft-versus-host disease (GVHD), a condition where the newly formed white blood cells begin attacking healthy tissues and organs. GVHD is the leading cause of complications and death following a stem cell transplant.

Treatment for GVHD varies from person to person and will depend on whether a person has the acute or chronic (or overlapping) type of GVHD, the symptoms they are experiencing, the severity of symptoms, the organs or areas of the skin that are affected, a person’s overall health, and other factors.

Treatment for GVHD often involves taking medications called corticosteroids and immunosuppressants. It may also involve taking other medications.

Corticosteroids

Corticosteroids—also called glucocorticoids—function like synthetic versions of the hormone cortisol. Cortisol is an anti-inflammatory hormone made in the adrenal glands. Corticosteroids have a powerful anti-inflammatory effect on the body and also reduce immune system activity.

Corticosteroids are used to treat a wide variety of conditions. They are a mainstay of treatment for GVHD and preventing complications after transplant procedures.

• Topical corticosteroids—creams or gels which are applied directly to the skin—may be prescribed to treat rashes caused by GVHD.
• Systemic corticosteroids that are taken as pills or given via an infusion are also used to treat GVHD.
• Corticosteroid mouthwash is also prescribed to treat mouth sores caused by GVHD.

Immunosuppressive drugs

As the name implies, immunosuppressive drugs suppress the immune system. Immunosuppressive drugs are typically prescribed (sometimes alongside corticosteroids) after a person has undergone an allogenic SCT, to help prevent the newly forming immune cells from attacking the body. Immunosuppressive drugs come in a variety of forms, including oral, topical, and intravenous. If a person develops GVHD, treatment may involve increasing the dosage of the medications a person is already taking or taking different medications.

Steroid-refractory GVHD

Sometimes GVHD does not respond initial treatment. If this occurs, there are numerous other medications a healthcare team may prescribe. These medications include:

• Targeted therapies. Targeted therapies block the function of specific molecules. They are used to block the growth and spread of certain cancers. With GVHD, certain targeted therapies can block the immune cells that are damaging the body.
• Photopheresis. In this procedure, a quantity of blood is drawn from a vein and circulated through a photopheresis machine. As the blood circulates through the machine, white blood cells are exposed to ultraviolet light.
• Biologic therapies. Biologic therapies work by blocking certain pathways in the immune system. These drugs are often used to treat autoimmune disorders and other inflammatory diseases.
• Chemotherapy. Chemotherapy drugs are used to treat GVHD because they break down immune cells called T cells and prevent these cells from attacking the body.

Some of these medications are indicated for the treatment of GVHD, while others can be prescribed off-label—meaning they are indicated for other conditions but have shown to be beneficial in the treatment of GVHD.

Working with your healthcare team

Remember, GVHD is a different experience for each person. Your best source of information about your diagnosis and treatment will be your healthcare team. Anytime you start a new medication:

• Ask your healthcare providers an explanation of how the medication works and how it treats GVHD.
• Get clear instructions on how the medication needs to be used, including the dosage you are taking and the dosing schedule.
• Keep copies of your prescriptions, which will have the brand name, generic name, and dosage.
• Ask about potential side effects that can occur when taking the medication.
• Ask how your progress with treatment will be monitored.
• Ask what happens if the medication doesn’t work and what your next steps in treatment will be.