What Is Graft-versus-Host Disease?

Graft-versus-host disease (GVHD) is a common complication following a transplant using cells from a donor (allogeneic transplant). It is NOT an issue for patients who were transplanted with their own stem cells (autologous transplant).

GVHD occurs when the donor's immune system (the graft) perceives the patient's organs and tissues (the host) as unfamiliar cells that should be destroyed.

The donor cells that trigger this reaction are a type of white blood cell called T-cells. They are part of the immune system and help protect the body against infection and fight cancer.

Approximately 50 percent of patients transplanted with donor cells develop graft-versus-host disease after transplant. Most cases of GVHD are mild or moderate and resolve over time. However, GVHD can be more severe and, in some cases, life-threatening.

Patients who develop GVHD usually do so within the first year after transplant. However, GVHD can also occur months or years later.

Two Types of GVHD

There are two forms of GVHD: acute GVHD and chronic GVHD. Patients may develop one, both or neither.

Each has a different effect on organs and tissues. Although acute and chronic GVHD usually occur during different time periods after transplant, it is possible to have both at the same time.

Acute GVHD usually affects one or more of these organs:

• skin
• gastrointestinal tract
• liver

Visit the Acute GVHD [1] section of our website for more details about organs affected by acute GVHD and treatment options.

Chronic GVHD can affect many more organs. Chronic GVHD most often affects the:

• skin
• eyes
• mouth

Chronic GVHD can also affect the:

• nails
• hair
• sweat glands
• joints
• fascia (the connective tissue under the skin that attaches to muscles and other organs)
• liver
• lungs
• genitals
• muscles
• rarely, the nervous system

Visit the Chronic GVHD [2] section of our website for more details about how chronic GVHD affects organs and tissues and treatment options. 

Treatment Options

GVHD is typically first treated with steroids such as prednisone. If the GVHD is not extensive, a topical steroid, like a cream or oral rinse, may be given. If the GVHD is more severe or widespread, systemic steroids that can reach many different organs and tissues may be needed.

If steroids are not effective in managing GVHD,  a number of other drugs and therapies are available.  Go to the  Drugs Used to Treat GVHD [3] section of our website for more details about drugs and other therapies used to treat GVHD.

GVHD and Infection

Many drugs used to treat GVHD can weaken your immune system. This increases your risk of developing a serious infection. You may be need to take medication to help prevent infections and be careful about potential sources of infection in your environment. 

Go the Infection and GVHD [4] section of our website for more details about measures you can take to reduce your risk of developing an infection.

Coping with the Stress of Living with GVHD

Living with GVHD can be an emotionally difficult experience for both patients and their family. It's normal to feel anxious or sad while dealing with GVHD.

Let your doctor know if you are feeling anxious, depressed  or confused, or are having exaggerated feelings of anger, excitement or sadness. Consulting a mental health professional can often help you deal with these emotions.

If a social worker or psychologist at your transplant center is not available to help you, you can find a mental health provider who is familiar with graft-verus-host disease in BMT InfoNet's Directory of Mental Health Providers [5]. Many can provide services both face-to-face as well as online using Zoom, or similar platforms.

Sometimes medications are offered to GVHD patients to stabilize mood swings and reduce anxiety.

Go to the Coping with the Stress [6] of GVHD page on our website for more information about managing emotional challenges associated with GVHD.

Caregivers for GVHD Patients

If you are the caregiver for someone who has GVHD, it can be a big job. It's hard to keep on top of all the things you need to do such as:

• providing medical care that was previously provided by nurses in the hospital
• making sure the patient takes a host of medicines on time and follows doctor's instructions
• coordinating transportation to clinics and specialists
• monitoring the patient for new symptoms and reporting them to the transplant team

while attending to your other daily duties and needs. Although it can be hard to do, it is important to take care of YOUR physical and emotional wellbeing while caring for your loved one.

Watch a video about GVHD

#GVHD

If you use social media, learn more about living with graft-versus-host disease and advances in treatment at #GVHD. Connect with others and show your support for GVHD patients.

(To view this page in Spanish click here [7])

Next page:  Acute Graft-versus-Host Disease [8]

Updated August 2023