Chronic Graft Versus Host Disease (cGVHD) occurs after a transplant when the immune system of the donor attacks and damages the tissues and organs of the patient. It can involve many parts of the body. Although most patients with cGVHD need many years of treatment, the good news is that active cGVHD most often goes away within 5-8 years, though not always without permanent damage. The medical care of cGVHD is a profound team effort in which success depends on close cooperation between healthcare providers, patients, and caregivers.
Chronic GVHD is the most common complication of allogeneic bone marrow transplants. As transplants have become safer and many more are performed, the number of people who ultimately develop cGVHD has grown. This has been accompanied by intensified research and clinical trials into cGVHD prevention and treatment.
Note: acute GVHD is any reaction that occurs within the first 100 days after transplant, and chronic GVHD refers to reactions that typically occur after 100 days.
The above description is taken directly from the introduction by Steve Pavletic, of the National Institutes of Health, from the nbmtLINK book “Graft Versus Host Disease: Understanding & Living with the After Effects of Bone Marrow/Stem Cell Transplant.”
Treatments for cGVHD depend on how early it is caught, how bad it is, and what organs it affects. Finding symptoms early is vital. Certain problems, such as dry eyes, may be permanent, so the sooner it is noticed and treated, the better. Other problems, such as skin rashes can go away completely.
Treatment is based on which organ is involved. If cGVHD is severe or if more than one organ system has cGVHD, systemic immunosuppressive treatment may be used. Systemic treatment affects the whole body.
Recently, the FDA (Food and Drug Administration) approved ibrutinib (Imbruvica®) for the treatment of adults with cGVHD after failure of one or more lines of therapy. This is the first drug to be FDA approved for cGVHD, and hopefully there will be more to come; research studies are ongoing.
In general, current treatment strategies are based on knowledge acquired from prior experience and research studies. Clinical trials (research studies) for acute and chronic GVHD treatments are taking place all over the country. You may want to think about joining a clinical trial, especially if your cGVHD has come back or has become worse after treatment.
The National Bone Marrow Transplant Link, established in 1992, strives to help patients, caregivers, and families cope with the social and emotional challenges of bone marrow/stem cell transplant from diagnosis through survivorship by providing free programs and personalized support services.
The information in these resources should not be construed as medical advice. Please consult with your health care provider regarding your medical decisions and treatment. The listed resources are not intended to be endorsements.
