GVHD Post Bone Marrow Transplant – What you should know?

GVHD is the abbreviation for Graft-versus-host-disease. We are going to use the abbreviation in the article at all times. GVHD, the bone marrow donated, perceives the body of the recipient as foreign and the bone marrow donated attacks the body. There are two types of GVHD namely acute and chronic. GVHD is an immune condition that may occur post bone marrow transplant mostly in allogeneic bone marrow transplant. This is a side effect after the transplant.

Bone marrow transplant cost in India ranges between 15 lakhs to forty lakhs INR.

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

As mentioned earlier, it is an immune condition that may happen post allogeneic bone marrow transplant. In GVHD, the donated stem cells perceive the recipient’s body as a foreign body and the donated cells attack the body. The two types of GVHD are:

  • Acute GVHD
  • Chronic GVHD 

If you have undergone allogenic bone marrow transplant, then you might experience either form of GVHD or both or neither of them. The chance of developing GVHD is around 30-40% when the donor and recipient are related and when they are unrelated the chances are 60-80%. GVHD may affect many organs in the body.

Allogeneic transplant is the most common bone marrow transplant in India prescribed to treat blood disorders or cancers. The team of doctors is the best who may help prevent occurrence of GVHD.

Risk factors in Acute GVHD:

Several factors are responsible for the development of acute GVHD. This occurs within 100 days of bone marrow transplant. The most common is the match of the donor and recipient Human Leukocyte Antigen (HLA) in which there are differences between the donor and the recipient. The difference leads to donor cells recognized to be foreign cells, leading to immune response against your organs and tissues.

Recipients who have received stem cells from an HLA mismatched donor or from an HLA matched unrelated donor have an increased risk of developing acute GVHD.

Some other factors that may increase the risk of acute GVHD are:

  • A female donor who has been pregnant before.
  • The advanced age of the donor or the recipient.

Acute GVHD occurs when the donor’s cells have been engrafted in the transplant recipient. It might appear in your skin, gastrointestinal or liver tract and symptoms might appear within weeks after the transplant.

Symptoms of acute GVHD:

  • Skin rash or redness areas on the skin
  • Yellow discoloration of the skin or eyes, abnormal blood test results
  • Diarrhea, nausea, vomiting or abdominal cramping
  • Itching also known as pruritus

Risk factors in Chronic GVHD:

Patients who have high risk of chronic GVHD are:

  • Advance age transplant recipients
  • Patients who might have experienced acute GVHD
  • Recipients who might have received bone marrow from an HLA mismatched related donor or from an HLA matched unrelated donor.

When and where chronic GVHD may occur?

Chronic GVHD may occur anytime after allergenic bone marrow transplant or after several years after the transplant. It might occur in the lungs, skin, liver, mouth, neuromuscular system, genitourinary tract and gastrointestinal tract. GVHD is the result of complex interaction between the host tissues and immune cells.

While it is seen that GVHD has a deep impact on quality of life, it also has some benefit. The same immune responsible for attacking your cells is also monitoring and destroying any cancer surviving cells. This is called graft versus tumor effect. Recipients who develop chronic GVHD have lower chances of disease relapse.

Symptoms of chronic GVHD:

  • Pain in intercourse and vaginal dryness
  • Fatigue, weakness  in the muscle and pain
  • Rash, discolored areas, skin tightening or thickening.
  • Change in the vision and dry eyes
  • Shortness of breath
  • Weight loss or pain while swallowing
  • Abnormal blood test results and abdominal swelling
  • White patches inside the mouth, dry mouth, pain and sensitivity to spicy food
  • Decreased range of motion in joints and tightness in joints
  • Hair loss

How is GVHD diagnosed?

It is diagnosed through a physical examination by observing certain symptoms and by evaluating the results of biopsy and lab tests. In case of chronic GVHD, some symptoms may be very vague which might make the diagnosis possible.

Gleneagles Global Hospitals is the best hospital for bone marrow transplant in India with the best bone marrow transplant doctors and surgeons. The hospital today is recognized as the best bone marrow transplant hospital in India.

How is GVHD treated?

If it’s acute GVHD, your doctor will discuss available treatment options with you. Many recipients are treated with the help of immunosuppressant orally or intravenous steroid medicines given through the vein. If this treatment is unsuccessful then other treatment options are suggested.

If it’s chronic GVHD, your doctor will discuss available treatment options with you. Usually, long term immunosuppressant medicines are the treatment regimen for chronic GVHD. Since your immune system will be suppressed for a very long time, fungal, bacterial, and viral infections are a major risk with this treatment option. These infections are life threatening for which your doctor will prescribe several medicines to help prevent these infections. The treatment may take upto months and years.

How can GVHD be prevented?

To reduce the risk of GVHD, your doctor will give you preventive medicines to suppress the immune system after your transplant. These medicines will decrease the ability of donor cells to start an immune response against their own tissues. You will be on preventive, antifungal and antiviral medicines to decrease infection risks. Antibiotics like prophylactic.

Last words:

Researchers are finding better preventive ways to reduce the risk of GVHD. Some of the recent research includes use of photopheresis (immunosuppressant drug) and new prophylaxis medications which are given to recipients after the transplant of bone marrow.