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What is graft-versus-host disease (GVHD)?

When you have a stem cell transplant with healthy cells from a donor’s blood or bone marrow, you get a whole new immune system. Its job is to help keep you healthy by monitoring your body and attacking anything it detects that doesn’t belong there, like bacteria, viruses, and even cancer cells.

Sometimes, however, those donor immune cells (the graft) begin to see your body (the host) as unfamiliar and foreign. As a result, the donor cells may launch an attack on your organs and tissues, causing graft-vs-host disease (GVHD).

GVHD is different for every patient. It can affect many parts of the body. The symptoms can erupt shortly after transplant or many months later. And while many cases are mild or moderate and get better over time, some cases can become more severe and even life-threatening. It can be hard to predict exactly who will get GVHD and how serious it will be. But in some patients, symptoms can go from mild to severe quickly.

That’s why it’s very important to watch for GVHD signs and symptoms and to call your transplant team right away if you see any—even if they seem minor or you’re not sure they could be GVHD.

Diagnosing and treating GVHD as soon as possible gives your care team the best chance to help you. Once GVHD is diagnosed, it is also given a grade based on the signs and symptoms and the number of organs affected. Grading helps your transplant team decide how to manage your GVHD and helps them monitor changes.

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GVHD can surface quickly or months after a stem cell transplant. Your best bet: report any signs or symptoms right away.

What types of GVHD can develop?

There are two main types of GVHD. Each affects a transplant patient’s organs and tissues differently. Sometimes, only one organ is affected. Sometimes, many are.

Acute GVHD usually happens within the first 3 months of transplant, but it can sometimes start or return later. Most often, it affects the skin with a sunburn-like rash as well as the liver, stomach, and intestines. If you experience acute GVHD, you’ll have a higher risk for chronic GVHD.

It’s important to know that acute and chronic GVHD have key differences other than when the signs and symptoms occur.

Chronic GVHD usually develops more than 3 months after transplant and can involve more organs and tissues than acute GVHD does. It often affects the skin and nails, by causing a dry, itchy rash and changes in the color, thickness, and texture of nails. Other common sites are the mouth, eyes, and liver. Less often, chronic GVHD affects the lungs, joints, genitals, and other parts of the body.

It’s important to know that acute and chronic GVHD have key differences other than when the signs and symptoms occur.

Image of a man and a woman outside
Image of a man and a woman outside

An upside to early GVHD?

If you had a stem cell transplant to treat cancer, your care team may see early, very minimal acute GVHD symptoms as a positive sign. It can show that the new immune system from your donor cells is taking hold (engrafting) and working to destroy any lingering cancer cells.

Who’s at risk?

It’s still hard to predict exactly who will get GVHD after stem cell transplant, but the chances can be higher in:

  • Patients whose transplanted cells came from a poorly matched or unrelated donor
  • Male patients whose transplanted cells came from female donors
  • Patients whose cells came from a female donor who has given birth
  • Patients whose transplanted stem cells came from their donor’s blood instead of their bone marrow
  • Patients who are older or whose donors are older
  • Patients who undergo high-intensity radiation and/or high-dose chemotherapy regimens before their transplant

Your transplant team takes steps to help lower your risk for GVHD along the way.

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Did you know?

In the last decade, revolutionary new technologies have helped researchers to identify specific biomarkers in the body that could help predict who gets GVHD and how likely it is to get worse. Biomarkers—which include proteins and other molecules involved in a specific disease process—are the key to personalized medicine. Once identified, they can also help scientists develop new treatments that target specific biomarkers and help “take down” diseases like GVHD.

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I heard about GVHD every step of the way, but I didn’t develop symptoms until 8 months after my transplant. When it hit, the bathroom emergencies were horrible. I called the contact number for my transplant center at 3 AM and a doctor from the team actually answered the phone at home. She told me to head to the center right away and go directly to the transplant floor, which is where they diagnosed GVHD and started treatment...I’m really lucky to have such a great team.

Benton B.

2018 transplant recipient

Where are you on your transplant journey?

Click to see what steps you can take along the way to help with GVHD.

  • Pre-transplant

    What happens before stem cell transplant?

  • During the hospital stay

    What happens after the transplant?

  • Transitioning to home

    What to expect after discharge

  • First year after transplant

    What should I be aware of?

  • More than one year after transplant

    What to keep in mind

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Getting the GVHD care you may need

Since GVHD can be unpredictable and varies from person to person, your transplant team may try different ways to manage it, or combinations of them, before finding what works for you. And over time, your needs may change.

Be sure to speak up! Your healthcare providers count on it. You should also feel free to ask questions.

Image of a healthcare provider with their hand on a patients shoulder Image of a healthcare provider with their hand on a patients shoulder