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Acute Graft-Versus-Host Disease (GVHD)

Acute GVHD usually happens within the first 3 months after a stem cell transplant from a donor’s blood or bone marrow. But it can also start or come back later.

Acute GVHD can progress quickly as the donor immune cells (the graft) just introduced to your body (the host) see your tissues as foreign and launch an attack on them.

The earliest sign of acute GVHD is usually a mild rash on the back or abdomen, sometimes on the hands or feet. As the rash spreads, it can look like a sunburn, with peeling or blisters. Acute GVHD can also cause gastrointestinal symptoms, such as abdominal pain or cramps, nausea, vomiting, and diarrhea. Your liver may also be affected. Sometimes, that causes jaundice, a yellowing of your skin or the white of your eyes. Your care team can usually diagnose acute GVHD based on the signs and symptoms you’re experiencing. Sometimes, tests such as biopsies and blood tests, are also done to confirm the diagnosis.

Signs and Symptoms of Graft-versus-Host Disease

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Graphic of a hand with a rash

Skin

  • Very faint to severe sunburn-like rash
  • Blisters
Graphic of a liver

Liver

  • Jaundice (your skin or eyes look yellow)
  • Dark tea-colored urine
  • Pain in the upper part of your belly
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Stomach

  • Nausea that doesn’t go away
  • Loss of appetite
  • Vomiting
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Intestines

  • Diarrhea
  • Belly pain that doesn’t go away
  • Feeling bloated or full of gas
  • Blood in your stool
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Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
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Mouth and Throat

  • Painless, lacy white lines on tongue or inner cheeks
  • Sores or irritation
  • Trouble opening your mouth
  • Pain and sensitivity to temperature and spices
  • Dry mouth, increasing risk for cavities along gums and between teeth
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Nervous System

  • Weakness, tingling, numbness in legs and feet
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Lungs

  • Cough that doesn’t go away
  • Shortness of breath
  • Trouble breathing
Graphic of a digestive system

Digestive System

  • Nausea or vomiting
  • Diarrhea
  • Belly pain or cramping
  • Liver symptoms, such as yellowing of the eyes or skin
Graphic of the genital area

Genitals

  • Irritation or dryness
  • Rash
  • Painful intercourse
Graphic of a hand with a rash

Skin, Nails, and Hair

  • Skin texture changes (thickening)
  • Nail changes
  • Rash
  • Unusual hair loss or thinning
  • Itchy skin
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Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
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Contact your transplant team right away if you notice any of these signs or symptoms or if new ones develop after you start treatment. Early diagnosis and intervention are important!

What’s happening in my body?

Acute GVHD is primarily an inflammatory reaction, set off by the new immune cells from your donor (the graft) that are now inside your body (the host). The irradiation and chemotherapy (called conditioning) that you receive before transplant can also set the stage for inflammation.

Among those donor cells you receive are certain white blood cells known as T cells. Their job is to help keep you healthy by traveling through your body’s lymph system and blood like a special forces unit, patrolling for foreign invaders that they are designed to watch out for and destroy.

There are two types of T cells. Killer T cells do the work of attacking and destroying cells they’ve identified as intruders that don’t belong there. Helper T cells interact with killer T cells to help them carry out their job.

Some helper T cells migrate to target tissues and help coordinate the attack. They send out chemical messages to help the activated killer T cells and others make lots of copies of themselves, so they build up a stronger army for their attack.

This is the same way your body typically reacts to fight off an infection that your immune system identifies. With acute GVHD, however, it’s the T cells that originated from your donor that sometimes see your own healthy cells as the foreign invaders they need to get rid of.

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Did You Know?

Acute GVHD mostly targets the skin, gastrointestinal system, and liver because these organs have the body’s highest percentage of cells that help activate the body’s protective immune responses.

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How Common Is Acute GVHD?

  • Occurs in about 30% to 40% of patients who receive cells from a related donor
  • Occurs in about 50% of patients who receive cells from an unrelated donor
Image of a man and a woman face-to-face Image of a man and a woman face-to-face
Image of Linda S.

Near the end of my 6 weeks in the hospital (post-transplant), I developed a rash that started on my hands and went up my arm. They were pretty sure it was acute GVHD, and a biopsy confirmed it. I thought, no, not GVHD! But the doctor said it’s okay....It helped me relax considerably to realize we caught it very early and there are things you can do to fight GVHD.

Linda S.

2017 transplant recipient