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Chronic graft-versus-host disease (GVHD)

Like the acute form of the disease, chronic GVHD is also an immune response triggered by donor cells reacting to their new home in your body. But chronic GVHD is different from acute GVHD.

Chronic GVHD tends to develop and progress more subtly and slowly than acute GVHD does. Most patients develop symptoms sometime within the first year after transplant, and a small percentage develop symptoms later. Chronic GVHD can affect many organs and tissues. And while there’s still much to be learned about all of the biology at work, researchers now recognize that the chronic GVHD processes in the body are more varied and complex than they are with acute GVHD.

Your care team can diagnose chronic GVHD based on the signs and symptoms you’re experiencing.

Signs and symptoms of chronic graft-versus-host disease

Click on the icons below to learn more about symptom areas.

Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness

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Download the chronic symptoms watchlist  
Graphic of a man with dots in places where organs would be
 
 
 
 
 
 
 
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Graphic of a mouth and throat

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
Graphic of lungs

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
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Exclamation mark in a circle icon

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!

Signs and Symptoms of Graft-versus-Host Disease

Click on the icons below to learn more about symptom areas.

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
Download the chronic symptoms watchlist  
Graphic of an eye with a teardrop

Eyes

  • Dry eyes
  • Irritation that won’t go away
  • Blurred vision
  • Teary eyes
Download the chronic symptoms watchlist  
Graphic of a mouth and throat

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
Download the chronic symptoms watchlist  
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
Download the chronic symptoms watchlist  
Graphic of lungs

Lungs

  • Cough that doesn’t go away
  • Shortness of breath
  • Trouble breathing
Download the chronic symptoms watchlist  
Graphic of leg bones and knee cap

Joints and Muscles

  • Arthritis-like symptoms (pain and stiffness)
  • Muscle aches or pain, cramps, or weakness
Download the chronic symptoms watchlist  
Graphic of the genital area

Genitals

  • Irritation or dryness
  • Rash
  • Painful intercourse
Download the chronic symptoms watchlist  

Swipe to scroll symptoms

  • Graphic of a hand with a rash
  • Graphic of an eye with a teardrop
  • Graphic of a mouth and throat
  • Graphic of a digestive system
  • Graphic of lungs
  • Graphic of leg bones and knee cap
  • Graphic of the genital area
Exclamation mark in a circle icon

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!

Importance of early identification in chronic GVHD

Subtle manifestations of chronic GVHD may go undiagnosed for months, and this delay may worsen prognosis. Timely diagnosis is important to minimize irreversible tissue damage. New signs and symptoms post-transplant should be evaluated as potential chronic GVHD.

What’s happening in my body?

Chronic GVHD differs from acute GVHD not only in its timing, but also in terms of what’s happening in the body.

While both types of GVHD involve an attack on the host organs and an inflammatory reaction, chronic GVHD is thought to be similar to autoimmune diseases. These include psoriasis, scleroderma, and rheumatoid arthritis. Autoimmune diseases also occur when the body’s immune system attacks healthy organs by mistake. And both chronic GVHD and autoimmune disease involve some degree of tissue scarring and thickening (known as fibrosis). Over time, ongoing fibrosis can lead to organ damage.

Question mark in a circle icon

Did you know?

With chronic GVHD, most people remain on some type of therapy for 2 to 3 years, but this can vary. Some patients’ GVHD must be managed for longer periods.

Image of a man sitting and typing on his phone

How common is chronic GVHD?

  • 30% to 70% of patients who receive donor stem cells develop chronic GVHD
  • About 90% of patients who develop chronic GVHD do so within 1 year after transplant. After that, the risk tends to get lower
  • 2 out of 3 patients who develop chronic GVHD had prior acute GVHD
Image of a man sitting and typing on his phone Image of a man sitting and typing on his phone
Image of Josh O.
Image of Josh O.

I had GVHD, a head to toe rash, not long after leaving the hospital. And I still have some skin and mouth GVHD two years later…. I try to stay positive, focus on today and tomorrow, bringing joy to people’s lives and finding joy in mine.

Josh O.

2018 transplant recipient