Graft Versus Host Disease

Key Points
Condition associated with bone marrow transplants and sometimes with solid organ transplant, blood transfusion, and rarely in maternal-fetal transfusion
Occurs when immune cells from the donor create antibodies in the host
Most commonly affects the skin, GI tract and liver
Divided into two distinct subtypes, with differing presentations

Graft versus host disease (GVHD) is a condition resulting from bone marrow transplant. It occurs when immune cells from the bone marrow donor create antibodies in the recipient, which attack the affected person's body. Its effects are most often seen in the skin, GI tract, and liver.

GVHD is divided into two distinct subtypes, acute and chronic. Acute GVHD is an early stage of the condition, typically occurring in the first three months after organ transplant. Initial presentation consists of a rash of red, tender spots on the hands feet and face. The rash may grow together and become widespread, or become elevated or blistered. Acute GVHD may also be accompanied by fever, diarrhea (which may be bloody, indicating that the GI tract has been affected), jaundice, and abnormal liver function. Chronic GVHD is the later stage of the condition, occurring three months post-transplant, and primarily consists of an itchy, dry, elevated rash over much of the body, mouth dryness and sensitivity, dry eyes, and other skin issues (thickening, hardening, scaling, and hyper-hypopigmentation). It may also be accompanied by hair loss or premature graying, a descrease in sweating, jaundice (indicating that the liver has been affected), and lung or GI conditions. The one factor both subtypes of the condition share is an increased risk in the affected person for developing infection.

GVHD is most often seen after bone marrow transplants, but may occur after organ transplants, and both blood and mother-child transfusions. It may occur in anyone who has undergone transplantation.

Differential Diagnosis (Other conditions with similar appearance)
Acute
Chemoradiotherapy toxicity
Drug reaction
Viral exanthem

Chronic
Autoimmune diseases
Scleroderma

Diagnosis
Key Points
Diagnosis is typically based on appearance of symptoms in conjunction with clinical examination
Biopsies, imaging and blood tests will be performed to confirm diagnosis, determine the extent of the condition, and rule out other conditions

GVHD is typically diagnosed based on the appearance of symptoms after transplant in conjunction with a clinical examination. Other testing, including biopsy, imaging and blood tests will be performed to not only confirm the diagnosis and rule out other conditions, but to determine the extent of the condition.

Treatment
Treatment may not be necessary for mild cases confined to the skin
Primary goal of treatment is prevention
Use of immunosuppressant drug cocktails may assist in reducing severity
Treatment often predicated on severity of the condition

Treatment of GVHD is often predicated on the severity of the condition. Mild cases which are confined to the skin may resolve without treatment. The primary goal of treatment is prevention and lessening of severity of the condition. Typically, the condition is treated with a cocktail of immunosuppresants, and in more severe cases this cocktail may be accompanied by strong corticosteroids. These drug cocktails prevent the donor's immune cells from having the strength to continue to attack the affected persons's tissues. The most serious danger is the development of sepsis, or blood poisoning, which is the primary cause of death in persons with the condition. Other treatments which may help alleviate severe GVHD include monoclonal antibodies, photochemotherapy, and ultraviolet radiation therapy.