Summary about Disease
Graft-versus-host disease (GVHD) is a condition that can occur after a transplant of cells from one person (the donor) to another (the recipient). In GVHD, the donated cells, which are supposed to rebuild the recipient's immune system, instead attack the recipient's own tissues and organs. This happens because the donated cells recognize the recipient's cells as foreign. GVHD can range from mild to severe and can affect various parts of the body.
Symptoms
GVHD symptoms vary depending on the type (acute or chronic) and the organs affected. Common symptoms include:
Skin: Rash, itching, blistering, skin thickening, changes in skin color.
Liver: Jaundice (yellowing of the skin and eyes), elevated liver enzymes, abdominal pain.
Gastrointestinal tract: Nausea, vomiting, diarrhea, abdominal cramping, loss of appetite.
Eyes: Dry eyes, burning, irritation.
Mouth: Dry mouth, sores, difficulty swallowing.
Lungs: Shortness of breath, cough, wheezing.
Other: Weight loss, fatigue, joint pain, muscle weakness.
Causes
GVHD is caused by donor immune cells (T cells) attacking the recipient's healthy tissues. This typically occurs after allogeneic hematopoietic stem cell transplantation (HSCT), where the donor's stem cells are used to replace the recipient's damaged bone marrow. The donor T cells recognize differences between the donor's and recipient's human leukocyte antigens (HLAs), which are proteins on the surface of cells. These differences trigger an immune response, leading to the attack on the recipient's organs.
Medicine Used
Medications used to treat and prevent GVHD include:
Immunosuppressants: These drugs suppress the immune system to prevent or reduce the attack by donor cells. Common examples include:
Cyclosporine
Tacrolimus
Methotrexate
Mycophenolate mofetil
Sirolimus
Corticosteroids: Prednisone and other corticosteroids are used to reduce inflammation.
Extracorporeal Photopheresis (ECP): A procedure where blood is treated with light to reduce the activity of T cells.
Other therapies: Depending on the severity and organs affected, other treatments may be used, such as antibodies (e.g., anti-thymocyte globulin (ATG)), targeted therapies, or supportive care.
Is Communicable
GVHD is not communicable. It is not an infectious disease and cannot be spread from person to person. It is a complication arising from a transplant procedure and the resulting immune response.
Precautions
Precautions for individuals with GVHD focus on managing symptoms, preventing infections, and adhering to the treatment plan. These may include:
Strict adherence to medication schedules.
Avoiding exposure to infections (frequent handwashing, avoiding crowded places, wearing a mask).
Protecting skin from sun exposure.
Maintaining good oral hygiene.
Monitoring for signs and symptoms of infection.
Regular follow-up with the transplant team.
Dietary modifications (e.g., avoiding certain foods that can irritate the gastrointestinal tract).
How long does an outbreak last?
The duration of a GVHD "outbreak" (episode) varies greatly depending on the type (acute or chronic), severity, organs affected, and response to treatment.
Acute GVHD: Typically develops within the first 100 days after transplant. It can resolve within weeks to months with treatment, but some cases can be severe and life-threatening.
Chronic GVHD: Usually develops after 100 days post-transplant and can last for months to years. Some patients may achieve remission, while others require long-term immunosuppression.
How is it diagnosed?
GVHD is diagnosed based on a combination of factors:
Clinical presentation: The presence of characteristic symptoms, such as skin rash, diarrhea, or liver abnormalities.
Medical history: History of hematopoietic stem cell transplantation.
Physical examination: Examination of the skin, mucous membranes, and other affected organs.
Laboratory tests: Blood tests to assess liver function, kidney function, and blood counts.
Biopsy: A tissue sample from the affected organ (e.g., skin, liver, gastrointestinal tract) is examined under a microscope to confirm the diagnosis and assess the severity of GVHD.
Timeline of Symptoms
GVHD is categorized into acute and chronic, each with a different timeline:
Acute GVHD:
Onset: Typically within the first 100 days after transplant.
Early symptoms: Often include skin rash, diarrhea, nausea, vomiting, and abdominal pain.
Progression: Can progress rapidly, affecting multiple organs and causing significant morbidity.
Chronic GVHD:
Onset: Usually after 100 days post-transplant, but can sometimes occur later.
Symptoms: Can be similar to autoimmune diseases, affecting the skin, mouth, eyes, liver, lungs, joints, and other organs.
Progression: Can be slow and insidious or more rapid, leading to significant disability.
Important Considerations
Early detection and treatment are crucial for improving outcomes in GVHD.
GVHD can significantly impact the quality of life for transplant recipients.
Management of GVHD requires a multidisciplinary approach involving hematologists, oncologists, dermatologists, gastroenterologists, and other specialists.
Research is ongoing to develop more effective therapies and prevention strategies for GVHD.
Patient education and support are essential for helping individuals cope with GVHD and adhere to their treatment plan.
Long term follow up with the transplant team is essential to monitor for chronic GVHD and manage any long term complications.