Chronic Graft Versus Host Disease

What is Chronic Graft Versus Host Disease?

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.”

Overview of the Treatment Process

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.

nbmtLINK Resources

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.

Graft Versus Host Disease: Living With the After Effects of Bone Marrow/Stem Cell Transplant
This book brings together the knowledge of many experts in the field who have spent their careers helping patients and finding solutions for cGVHD. It meets the immediate and urgent need for patients, caregivers, and families to better understand and cope with the late effects of a bone marrow or stem cell transplant. Includes introduction by Steve Pavletic, of the National Institutes of Health
Season 7 Trailer : GVHD and the Long Haul
Season 7 of the Marrow Masters Podcast focuses on long haulers – those who are dealing with chronic graft vs host disease. The Season covers different treatment options, plus some topics that aren’t always easy to bring up. And it covers the importance of taking care of not just your physical health, but your mental health as well.
Chronic Graft Versus Host Disease and How It Affects the Lungs
This one hour audio program, addresses cGHVD of the lungs. Dr. Carrie Kitko, Associate Professor of Pediatrics and Medical Director of the Pediatric Stem Cell Transplant Program at Vanderbilt University Medical Center enlightens us on the challenges of diagnosing chronic lung GVHD, the potential novel treatments available and how these newer agents may be able to go beyond stabilization of the disease by targeting fibrosis, the main culprit.
Improving the Quality of Life for Patients with GVHD Through Occupational Therapy, Good Nutrition and Psychosocial Strategies
This webinar focuses on OT interventions and nutrition factors that can improve the quality of life for GVHD patients. In addition, we cover the emotional toll of GVHD and offer advice to better handle it with tips from patients dealing with GVHD.

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.