Nurse Visit part 2: Graft versus Host Disease (GvHD)

Graft versus Host Disease in a condition that can occur after an allogeneic transplant in which "the donated bone marrow view the recipient's body as foreign, and the donated marrow attack the body." (Cleveland Clinic Foundation, 2014).

It can be either Acute (aGvHD) or Chronic (cGvHD). Todd could get one, both, or experience neither. 

Since Todd is receiving his bone marrow donation from his brother, who is considered to be a "perfect" 8 of 8 point match donor, the risks of developing GvHD are somewhat lower. His young age also helps decrease this risk. 

If  acute GVHD occurs, it will usually show up when his brother's cells have "grafted" into Todd's body (within weeks).  Chronic GvHD can develop anytime, even years after the transplant. 

Acute GvHD usually develops in the skin, liver, eyes, or gastrointestinal tract.
Symptoms include:

Skin: rash or reddened skin

Liver: abnormal blood tests (liver) and/or yellow discoloration of the skin/eyes

Gastrointestinal: nausea, vomiting, diarrhea, or abdominal cramping. 

Eyes: increased dryness/irritation. 

Chronic GvHD can manifest itself in these same areas, but in additional places too including the mouth, lungs, neuromuscular system, and/or genitourinary tract (bladder/sexual organs).
Symptoms for these areas include: 

Mouth: dry mouth, white patches inside the mouth, pain or sensitivity to spicy foods. 

Lungs: Shortness of breath, changes in chest X-rays. 

Gastrointestinal: difficulty or pain in swallowing. 

Neuromuscular: fatigue, muscle weakness, or pain. 

Genitourinary: urinary frequency, burning or bleeding with urination, or penile dysfunction. 

Many of his medications can cause similar side effects making diagnosis difficult. Detailed tests and consultations with specialists will help distinguish the difference. Checking current results with baseline test results taken prior to the transplant can be helpful.

While GvHD can be deadly in some rare cases, most cases can be counter-acted with medications, though some can cause long-term side effects. Since Todd's brother is a perfect donor match, we are praying that the chances for developing GvHD are slim.

On the flip-side, GvHD does have some good benefits.  A slight case can be positive.  "The same immune response responsible for attacking your normal cells is also monitoring and destroying any surviving cancer cells."  (Cleveland Clinic Foundation, 2014). This is called the Graft versus Tumor Effect. In other words, Todd will have his brother's bone marrow in place of his own: normal, healthy bone marrow.  If any of Todd's original unhealthy bone marrow is still left, then Todd's new immune system from his brother will attack these old dysplastic or cancer cells.  Also, patients who develop GvHD have been shown to have lower disease relapse rates. 

So how can he avoid GvHD?  Using a perfect or best match donor's cells and giving him preventive immunosuppressant medicines after transplant.  Constant monitoring of symptoms is also imperative to diagnosing and controlling GvHD symptoms. 

A major time of developing or confronting GvHD is when the doctors take Todd off his immunosuppresant medications.  Some patients have to continue these medications for longer than the initial treatment time, sometimes for months, years, or indefinitely. 

I have done the best to describe GvHD as simple as possible.  I have used the information handout (Revised 2/27/2014) provided to us by The Cleveland Clinic Foundation in our transplant information binder.  Please follow this link to find this information online: http://my.clevelandclinic.org/services/Bone_Marrow_Transplantation/hic_Graft_vs_Host_Disease_An_Overview_in_Bone_Marrow_Transplant.aspx