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Read MoreUnderstanding Graft Versus Host Disease (GVHD): Symptoms, Diagnosis, and Treatment
Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on September 6th, 2023.
Key Takeaways
- Acute form strikes within 14-100 days post-transplant, causing sunburn-like skin rashes, severe diarrhea, and jaundice as donor immune cells attack the recipient's organs.
- Chronic form emerges after 100 days with autoimmune-like symptoms including thickened, scleroderma-like skin changes, sicca syndrome (dry eyes/mouth), and progressive joint contractures.
- High-dose corticosteroids (typically 1-2 mg/kg prednisone) serve as first-line treatment for acute cases, requiring rapid immunosuppression to prevent life-threatening complications.
- Long-term management of chronic cases involves multiple agents like cyclosporine, mycophenolate, and rituximab, often requiring years of coordinated care to prevent irreversible organ damage.
- Mortality rates differ dramatically—acute cases can be fatal within weeks without treatment, while chronic forms primarily impact quality of life through disability and functional impairment.
Graft versus host disease (GVHD) is a potential complication that can occur after a stem cell transplant, a treatment for blood cancers and certain blood or immune system disorders, after a bone marrow transplant. GVHD happens when the transplanted cells (graft) from the donor recognize the host cells as foreign and attack the recipient's (host's) body.
Types of GVHD
There are two main types of GVHD:
Acute GVHD: Usually involves the skin, gastrointestinal (GI) tract, and sometimes the liver. It often starts between 14 and 100 days after the transplant.
Chronic GVHD: Often involves the skin, GI tract, and liver to a higher degree than acute GVHD. It also affects more parts of the body and has some signs of an autoimmune disease. Chronic GVHD tends to start after the 100-day mark but may not come until years later.
Symptoms of GVHD
The symptoms of GVHD can vary depending on the type and the organs affected:
Skin: Sunburn-like rash, itching, pain, and sometimes blister-like lesions.
GI tract: Intense diarrhea, cramps, nausea, vomiting, and loss of appetite.
Liver: High levels of bilirubin and liver enzymes, and jaundice (yellowing of the eyes).
Chronic GVHD may also cause additional symptoms, such as thickened skin, dry mouth, dry eyes, muscle pain or weakness, and painful sex due to changes in the genitals.
Diagnosing GVHD
Your doctor may diagnose GVHD based on your symptoms alone or through a physical exam. In some cases, tests may be needed to confirm the diagnosis, especially for chronic GVHD. Chronic GVHD can be classified as mild, moderate, or severe, depending on the number of organs involved and the severity of the symptoms.
Treating GVHD
Treatment for GVHD is tailored to your symptoms and their severity. It may involve a team of experts and various medications, such as:
Immunosuppressants: Corticosteroids, cyclosporine, sirolimus, tacrolimus, and others to calm the immune system and reduce inflammation.
Immunomodulating agents: Thalidomide to suppress an inflammatory protein called tumor necrosis factor-α (TNF-α).
Photoactive agents: Methoxsalen to help treat skin lesions.
Antineoplastic agents: Ibrutinib, methotrexate, pentostatin, and ruxolitinib to inhibit the growth and multiplication of dangerous cells.
Monoclonal antibodies: Alemtuzumab, etanercept, infliximab, and rituximab to target specific cells involved in GVHD.
In addition to medications, supportive therapies may be important to help overcome or prevent other problems associated with GVHD.
Self-Care and Support
Taking care of yourself is crucial when dealing with GVHD. Some important steps include:
Avoiding infections by practicing good hygiene and avoiding contact with sick people.
Taking care of your skin by using gentle cleansers and moisturizers.
Protecting your eyes with UV-coated sunglasses and regular eye exams.
Maintaining good oral hygiene to prevent cavities and gum disease.
Eating a balanced diet and staying hydrated, especially if you have GI symptoms.
Engaging in gentle exercise to improve bone health, muscle strength, and sleep quality.
Emotional support is also essential when coping with GVHD. Consider joining a support group or seeking counseling to help manage any feelings of depression or anxiety.
Remember, you are not alone in this journey. With the right treatment, self-care, and support, you can manage the symptoms of GVHD and improve your quality of life. Don't hesitate to reach out to your healthcare team, family, friends, or support organizations for help and guidance.
Additional Resources
The Bottom Line
The timing and presentation of symptoms after stem cell transplant determines whether you need emergency immunosuppression or long-term supportive care. Early recognition is critical since acute cases can rapidly become life-threatening, while chronic forms require sustained management to preserve organ function. If you're experiencing post-transplant symptoms and need help determining the right treatment approach, Doctronic can guide you through the diagnostic and management process.
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