Graft-versus-Host-Disease (GvHD)

Graft-versus-disease is a common complication after a bone marrow, stem cell or cord blood transplant using cells from a donor.

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Graft-versus-Host Disease (GVHD) is a common complication following a transplant using donor cells. GVHD is not an issue for patients who had a transplant using their own stem cells.

What Is GVHD?

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

Between 20 and 50 percent of patients transplanted with donor cells develop graft-versus-host disease after transplant. The percentage is higher in:
  • older patients
  • patients who were transplanted with cells from an unrelated donor
  • patients transplanted with peripheral blood stem cells, rather than bone marrow or cord blood.

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.

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 Graft-versus-Host Disease (aGVHD)

Approximately 30-40 percent of patients who are transplanted with cells from a related donor develop acute GVHD. Approximately fifty percent of patients who are transplanted with cells from an unrelated donor develop acute GVHD. 

Acute GVHD typically occurs during the first three months after transplant, although it can also occur later.

The risk of developing acute GVHD is highest in patients who were transplanted with a mismatched or unrelated donor. 

Other factors that may increase the risk include:

  • total body irradiation before transplant
  • a female donor for a male patient
  • the type of drugs used to prevent acute GVHD

Preventing Acute GVHD

To reduce the risk of developing acute GVHD, patients are usually given medications starting a day or two before transplant such as:

  • cyclosporine and methotrexate
  • tacrolimus and methotrexate
  • cyclosporine and mycophenolate mofetil (MMF)
  • tacrolimus and sirolimus
  • antithymocyte globulin (ATG)

These drugs suppress your immune system, making it more difficult for the donor's cells to attack your organs and tissues. You may need to continue taking these drugs for several months after transplant. Your doctor may give you additional drugs after transplant, such as cyclophosphamide, to further reduce the risk of developing GVHD.

At some transplant centers, the T-cells that cause GVHD are removed from the donor's cells prior to transplant. This procedure is called T-cell depletion.

Although T-cell depletion reduces the risk of developing GVHD, it can increase the risk of relapse or infection in some patients. Researchers are exploring whether removing a subset of T-cells from the donor's cells will protect patients against GVHD without increasing the risk of relapse or infection.

Symptoms of Acute GVHD

In most patients, acute GVHD first affects the skin. It may cause:

  • a mild, faint rash on the back, shoulders, ears or neck
  • a rash on the palms of the hands or soles of the feet

The rash may resemble a sunburn with peeling or blistering, or may feel like a heat rash, and may eventually spread.

Acute GVHD can also affect the gastrointestinal tract causing:

  • stomach and intestinal pain
  • watery or bloody diarrhea
  • persistent nausea and/or vomiting
  • loss of appetite or feeling full after eating only a little

If acute GVHD affects the liver, it can cause:

  • elevated liver enzyme levels
  • jaundice (yellowing of skin and eyes)
  • dark urine

Tell your doctor immediately if you develop a skin rash or other symptoms of acute GVHD. Although these symptoms may be caused by other health problems, early detection and treatment of acute GVHD is important to prevent other, serious complications.

Treatment for Acute GVHD

If you develop acute GVHD, drugs such as prednisone or methylprednisolone may help control the disease. If your GVHD does not respond to these drugs, your doctor may try other treatments such as:

  • antithymocyte globulin (ATG)
  • sirolimus
  • mycophenolate mofetil (MMF)
  • extracorporeal photopheresis (ECP)

Extracorporeal photopheresis is a procedure that removes white blood cells from the the patient, mixes them with a drug called psoralen, and exposes them to ultraviolet light. The cells are then re-infused into the patient.

Your doctor may also recommend that you enroll in a clinical trial that is testing a new therapy for acute GVHD.

It's important to continue taking your medications for acute GVHD, even if you are feeling better.

Your doctor will begin tapering the dosage of the drugs once it appears that your acute GVHD is under control. It's possible, however, for acute GVHD to return or get worse during the tapering process. You may need to continue the medications for a longer period of time until the disease is no longer active.

Chronic Graft-versus-Host Disease (cGVHD)

Chronic graft-versus-host disease is a complication that develops in approximately 50 percent of patients who are transplanted with stem cells from a donor. Chronic GVHD is not a complication for patients who were transplanted with their own stem cells.

Chronic GVHD is different than acute GVHD. It usually develops later than acute GVHD and can affect more organs and tissues.

Most cases of chronic GVHD are mild or moderate. However, 10-15 percent of patients develop symptoms that are more severe.

Risk Factors for Chronic GVHD

Chronic GVHD occurs most often in patients who:

  • previously had acute GVHD
  • are older
  • had a mismatched or unrelated donor
  • were transplanted with stem cells collected from the bloodstream (peripheral blood stem cells), rather than bone marrow or cord blood
  • are male and received cells from a female donor
  • received cells from a female donor who had previously borne children

Organs Affected by Chronic GVHD

Chronic GVHD most often affects:

  • skin and nails
  • eyes
  • mouth
  • liver

Less frequently, chronic GVHD affects the:

  • lungs
  • intestines
  • joints
  • genitals
  • muscles
  • nervous system

Symptoms of Chronic GVHD

Like many conditions, chronic GVHD is easier to treat if detected early. Contact your doctor if you develop any of the following symptoms:

  • rash
  • skin discoloration
  • tightness or changes in texture of your skin
  • thinning hair
  • changes in texture of your nails
  • dry eyes
  • blurred vision
  • persistent dry mouth
  • mouth sensitivity to foods or toothpaste
  • vaginal dryness, irritation or tightening
  • penis irritation
  • nausea, vomiting, diarrhea, loss of appetite, unexplained weight loss
  • chronic cough, wheezing, shortness of breath
  • difficulty fully extending fingers, wrists, elbows, knees or ankles
  • fatigue
  • low grade fever

These symptoms may be caused by something other than chronic GVHD, but you should report them to your doctor immediately so that you can be evaluated.

Many primary care physicians are not familiar with the signs and symptoms of chronic GVHD. Ask your doctor to contact your transplant team, or call them yourself, if you suspect you may be developing chronic GVHD, since prompt treatment is important.

How is Chronic GVHD Treated?

How your doctor manages your chronic GVHD depends on which organs and tissues are affected, the severity of the symptoms and the impact chronic GVHD is having on your daily life.

If chronic GVHD is affecting only one or two organs or tissues, you doctor may choose a localized therapy, like a skin ointment, to manage your disease.

If it is affecting many different parts of your body, or if symptoms are severe and cannot be managed by a localized therapy, your doctor may need to give you drugs that suppress your immune system such as:

  • prednisone
  • prednisone with cyclosporine
  • prednisone with tacrolimus

If your GVHD does not respond to these drugs, your doctor may try other drugs such as:

  • ibrutinib (Imbruvica®)
  • methotrexate
  • mycophenolate mofetil (MMF, CellCept®)
  • sirolimus (Rapamune®)
  • extracorporeal photopheresis (ECP)
  • low-dose interleukin-2
  • ruxolitinib (Jakafi®)

Patients with chronic GVHD usually require treatment for three to five years.

Approximately 15 percent require treatment for a longer period of time and, in rare cases, may need life-long immunosuppressive drugs.  

If you are diagnosed with chronic GVHD, it is important that you take your medication even when you start to feel better. Stopping your medication too early can cause your GVHD to flare up again or worsen.

Watch a Video about Chronic GVHD (40 minutes)

Skin GVHD

Chronic GVHD often affects the skin, finger nails and toe nails, hair and sweat glands. Symptoms include:

  • dry, itchy rash
  • a burning sensation when exposed to sun or heat
  • a tightening or pulling sensation on the skin
  • a change in skin color
  • thickening of the skin that can restrict joint movement
  • taut skin
  • thin skin that tears easily

Skin GVHD may also cause:

  • brittle or splitting fingernails and toenails
  • hair loss or thinning hair
  • changes in hair color or texture
  • joint stiffness
  • contractures (shortening or hardening of muscles and connective tissues)
  • taut skin around the mouth, making it difficult to open the mouth
  • an inability to sweat or handle heat for long periods of time, due to damaged sweat glands
  • difficulty breathing, due to tight skin on the chest
  • feeling full quickly because the abdomen is taut
  • tightening of tissue under the skin (the fascia) which can look like cellulite

Corticosteroids or tacrolimus ointment applied directly on the skin may relieve the symptoms. If tight skin is restricting joint movement, physical therapy may help.

If skin GVHD is causing joint stiffness or contractures (shortening of muscle tissue), your doctor may recommend deep tissue massage or stretching exercises to improve your range of motion.

Extracorporeal photopheresis (ECP) is another treatment for skin GVHD. This procedure, which is not available at all transplant centers, removes some white blood cells from the patient, mixes them with psoralen, and exposes them to ultraviolet light. The cells are then re-infused into the patient. Find a hospital that offers ECP.

If you've ever had skin GVHD, it is important to protect your skin from exposure to the sun.

Skin GVHD can increase your risk of developing skin cancer.

When outside, wear a hat, long sleeves and pants. Use a strong sunscreen (SPF30 or higher) on any exposed skin. Keep in mind that the sun's rays can be just as damaging on a cool, cloudy day as they are on a hot, sunny day.

Companies like Sun Precautions® and Coolibar® offer sun protective clothing that can help shield your skin from the sun's harmful ultraviolet rays. The makers of RIT Dye make SunGuard™, a laundry detergent additive that will add sun block to your everyday clothing.

Watch a Video about Skin GVHD (42 minutes)

Mouth and GVHD (Oral GVHD)

Chronic GVHD often affects the mouth and salivary glands. Symptoms may include:

  • redness and lacy white patches in the mouth, often on the tongue and cheek
  • painful sores in the mouth
  • sensitivity to spicy, acidic or crunchy food, carbonated beverages and mint-flavored toothpaste
  • a very dry mouth
  • changes in taste
  • difficulty eating or swallowing food 

Chronic GVHD in the mouth is usually treated with:

  • a topical steroid gel or cream such as fluocinonide or clobetasol gel
  • an oral rinse containing dexamethasone, budesonide or prednisolone
  • tacrolimus either as a rinse or topical treatment
  • pilcarpine (Salagen®) and cevimeline (Evoxac®)

Medications such as lidocaine may be prescribed to control pain.

Lack of saliva in the mouth can lead to cavities. It is important to use good brushing and flossing at home, and use prescription fluoride therapy.

Patients with oral GVHD have an increased risk of developing cancer in their mouth. You should be checked annually, preferably by a specialist who is familiar with both GVHD and oral cancer, to look for any unusual lesions in the mouth.

Oral GVHD can make eating difficult. Get tips for managing eating problems after transplant.

Watch a Video about Oral GVHD (30 minutes)

Eyes and GVHD (Ocular GVHD)

Chronic GVHD can affect your eyes. Symptoms may include:

  • dry eyes
  • irritation, redness and pain
  • sensitivity to bright light or wind
  • an inflamed eyelid
  • scarring of the eye surface under the lids
  • excessive tears

The treatment for ocular GVHD eyes depends on the severity of the symptoms. Most cases can be managed with:

  • preservative-free artificial tear drops of ointments (preservatives in some eye drops can be toxic to eye tissues if used more than 3 times per day)
  • steroid drops or ointments
  • cyclosporine eye drops
  • plugging tear ducts so that moisture remains in your eyes
  • adding humidity to your home
  • wearing goggles to limit exposure to the wind

If the problem is more severe and is affecting your vision, your doctor may recommend:

  • eye drops made from your blood serum (autologous serum drops)
  • a bandage contact lens to protect the surface of the eye
  • a special type of contact lens called a scleral lens, offered by BostonSight® and others, that can relieve symptoms and improve vision

 

If you GVHD is affecting your eyes, be sure to wear sunglasses with UV protection when in the sun to protect your eyes from further damage.

Watch a Video about Ocular GVHD (40 minutes)

Lungs and GVHD 

Chronic GVHD sometimes affects the airway passages in the lungs causing:

  • shortness of breath
  • wheezing
  • coughing

Patients with pulmonary GVHD often do not have symptoms until the disease has progressed. Periodic pulmonary function tests are the best way to catch lung GVHD and begin treatment early, before the symptoms become severe.

If you develop pulmonary GVHD, you doctor may treat you with:

  • steroid inhalers
  • bronchodilators
  • tacrolimus
  • extracorporeal photopheresis
  • montelukast
  • azithromycin

If you notice any shortness of breath or other breathing problems, let your doctor know right away.  The earlier you report symptoms and treatment begins, the better the outcome.

You can help protect your lungs after transplant by:

  • avoiding tobacco products, e-cigarettes and inhaled marijuana
  • getting an annual flu shot 
  • making sure you vaccinations are up-to-date

Watch a Video about Pulmonary GVHD (30 minutes)

Liver, Gastrointestinal Tract and GVHD

Chronic GVHD sometimes affects the liver. Symptoms may include:

  • abnormal liver function tests (elevated liver enzymes)
  • jaundice (yellowing of the skin and eyes)
  • dark urine

These symptoms may also be caused by drugs you are taking, infection or gallbladder problems.  An ultrasound of the liver or liver biopsy may be needed to determine whether you have liver GVHD.

If you are diagnosed with liver GVHD, you doctor may recommend treatment with:

  • prednisone
  • tacrolimus
  • ursodeoxycholic acid

If these treatments fail, your doctor may try extracorporeal photopheresis to manage the problem.

Chronic GVHD can also affect the esophagus, stomach and colon. Symptoms may include:

  • difficult or painful swallowing
  • weight loss
  • nausea and vomiting
  • diarrhea

Tell your doctors right away if you are having symptoms of gastrointestinal GVHD. Other conditions such as infection, drugs you are taking, acid reflux and a fatty diet may cause similar symptoms.

If GVHD is affecting your gastrointestinal (GI) tract, your doctor may recommend treatment with:

  • prednisone
  • topical steroids such as budesonide or beclomethasone
  • infliximab (Remicade®)
  • etanercept (Enbrel®)
  • extracorporeal photopheresis (ECP)

If you are experiencing weight loss, talk with a dietitian to develop an eating plan that will provide you with the calories, proteins and other nutrients you need to recover. Learn some strategies for overcoming eating problems after transplant.

Watch a Video about Chronic GVHD of the Gastrointestinal Tract and Liver (40 minutes)

Genitals and GVHD

Sometimes, chronic GVHD affects the genitals.

In women, chronic GVHD can cause:

  • dryness, itching, ulcers and scarring in the vagina and on the external genital area
  • pain with sex
  • pain when urinating

Treatment options may include:

  • water-based lubricants
  • topical steroids
  • tacrolimus or cyclosporine ointments
  • vaginal suppositories
  • dilators to expand the vaginal canal
  • a surgical procedure to open the vaginal canal

Continuing to have sex after transplant can help the vaginal canal to remain open.

To minimize pain and irritation:

  • wash your genital area with warm water and soap
  • don't use perfumed products in the genital area
  • use loose cotton or cotton-lined underwear

In men, chronic GVHD may cause itching or scarring on the penis and scrotum. Topical steroids and tacrolimus are the usual treatment options.

Nervous System and GVHD

Sometimes chronic GVHD affects the nervous system. Symptoms may include:

  • numbness or a painful, tingling sensation in your hands and/or feet
  • a shooting pain in your hands and/or feet
  • lack of coordination

These problems, caused by nerve damage, are called neuropathy. Depending on the severity, neuropathy may be treated with:

  • a topical medication such as a lidocaine patch or gel
  • oral medications such as amitriptyline, gabapentin or pregabalin
  • physical and occupational therapy
  • soaking feet in cool water
  • massage therapy
  • acupuncture

Tell your doctor if you have symptoms of neuropathy. A consultation with a neurologist can determine the best treatment for you.

If neuropathy is affecting your feet:

  • wash your feet daily with lukewarm water and a fragrance-free soap
  • inspect your feet daily for cuts, bruises, cracking and other changes that may require attention
  • wear sturdy shoes and slippers at all times
  • do not apply direct heat to your feet and legs
  • avoid falls by keeping your living area free of clutter and slippery surfaces
  • consider using hand rails, canes and other assistive devices to help maintain balance

Click here to learn more about managing neuropathy after transplant.

Muscles and GVHD

In rare cases, chronic GVHD may cause muscle weakness. Your doctor will test to see whether other health issues or GVHD is responsible for the problem.

Drugs that suppress the immune system may be used to control muscular GVHD.

Infection and GVHD

Many drugs used to treat GVHD weaken your immune system. This increases your risk of developing an infection.

Your transplant doctor may put you on antibiotics to prevent a serious bacterial infection, or give you antibiotics to keep on hand in case you develop a fever. You may also receive medications to prevent viral and fungal infections.

Wash Your Hands

Your transplant team will give you guidelines to help prevent infection while your immune system is weak.

The most important guideline is to frequently and thoroughly wash your hands with soap and water before

  • eating or preparing food
  • taking medications

Be sure you wash your hands after

  • touching catheters or wounds
  • changing diapers (if you are permitted to do so)
  • touching plants or dirt (If you are permitted to do so)
  • going to the restroom
  • touching animals
  • touching bodily fluids or items that might have come in contact with bodily fluids such as clothing, bedding or toilets
  • going outdoors or to a public place
  • removing gloves
  • collecting or depositing garbage (if you are permitted to do so)

Avoid Exposure to Sources of Infection

Until you are off immunosuppressive drugs, you'll want to avoid exposure to sources of infection. You transplant team may recommend that you avoid:

  • crowds
  • people who have, or have been exposed to, infections
  • people who have recently been vaccinated for chicken pox, polio, shingles or the flu
  • changing a baby's diaper
  • gardening or digging in dirt
  • smoking or being around people who smoke cigarettes, cigars, a pipe or marijuana
  • walking, wading, swimming or playing in ponds or lakes
  • construction sites and remodeling projects

Cleaning kitchen counters and bathrooms daily with a solution of one part bleach to ten parts water can help eliminate sources of infection.

Ask your Transplant Team about Pets

Rules vary among transplant centers about whether or not you can have pets at home while your immune system is suppressed. 

Your transplant team may ask you to avoid:

  • cleaning litter boxes or cages, disposing of animal waste, or other activities that put you in touch with animal feces
  • adopting ill or juvenile pets
  • bird droppings
  • cleaning fish tanks
  • an animal that is sick
  • reptiles such as lizards, snakes, turtles and iguanas, and items they touch
  • chicks and ducklings
  • exotic pets such as monkeys and chinchillas

Your doctor may also recommend

  • keeping cat litter away from areas where food is served
  • keeping cats indoors
  • not adopting stray cats
  • covering backyard sandboxes to prevent cats from using it as a litter box.

Be sure your vaccinations are up-to-date and carefully follow your doctor's instructions to avoid sources of infection until you are no longer on drugs that suppress your immune system. At the first sign of an infection, call your doctor so that you can get prompt treatment and avoid serious complications.

Even infections that you would normally ignore can pose a serious threat to you while your immune system is weak. Infections that are caught early are often easier to treat.

Side Effects of GVHD Treatment

The drugs used to prevent and treat chronic GVHD have side effects. Most are temporary and end when the drug is discontinued.

The drugs listed below are those used most commonly to prevent and treat GVHD. The side effects listed have been reported in 10 percent or more of people treated with the drug or therapy. Other, rarer side effects have also been reported.  Consult your doctor for details.

Antithymocyte Globulin (ATGAM, Thymoglobulin®) may cause:

  • infusion reactions: fever, chills, low blood pressure, skin rash
  • joint pain
  • headache
  • nausea, vomiting, diarrhea
  • night sweats
  • dizziness
  • shortness of breath
  • low platelet and white blood cell counts
  • infections

Cyclosporine (Gengraf®, Neoral®, Sandimmune®) can cause:

  • kidney problems
  • headaches
  • tremors, muscle cramps
  • increased body hair
  • seizures
  • nausea, diarrhea, abdominal discomfort
  • high blood pressure

Extracorporeal Photopheresis (ECP) can cause:

  • sensitivity to sunlight and other sources of UV light
  • skin redness
  • fever
  • low blood pressure
  • rapid heart rate
  • low red cell and platelet count

Ibrutinib (Imbruvica®) can cause:

  • fatigue
  • bruising
  • rash
  • diarrhea, nausea
  • low platelet count
  • muscle spasms
  • mouth sores
  • pneumonia
  • brittle nails
  • abnormal heart rhythm

Interleukin-2 (IL-2, Proleukin®) may cause:

  • infusion reactions: fever, chills, low blood pressure
  • flu-like symptoms, general aches and pains
  • redness on the face and body
  • rash
  • nausea, vomiting, diarrhea
  • low blood counts
  • confusion, drowsiness or temporary memory loss
  • fast heart beats
  • low urine output
  • swelling of face, ankles or legs
  • difficulty breathing

Methotrexate (Rheumatrex®) can cause:

  • mouth sores
  • skin redness
  • nausea, vomiting, diarrhea
  • elevated uric acid
  • kidney problems
  • liver problems
  • low blood counts

Mycophenolate mofetil (MMF, CellCept®)  can cause:

  • nausea, vomiting, diarrhea
  • bleeding
  • increased risk of infection
  • anemia
  • low calcium and magnesium
  • high potassium
  • cough, breathing issues

Prednisone and Prednisolone can cause:

  • osteoporosis (weak and brittle bones)
  • joint deterioration, which may require joint replacement
  • increased risk of infection
  • cataracts
  • weight gain
  • moon face
  • mood swings
  • depression
  • high blood sugar
  • high blood pressure
  • gastric ulcers
  • muscle weakness

Ruxolitinib (Jakafi®) may cause:

  • low blood counts
  • bruising
  • dizziness
  • headache
  • elevated liver enzymes
  • high cholesterol

Sirolimus (Rapamune®) can cause:

  • increased risk of infection
  • increased risk of bleeding
  • high blood sugar
  • swelling 
  • fever
  • low blood counts
  • kidney problems
  • constipation, diarrhea
  • sepsis, infection

      Tacrolimus (Prograf®) can cause:

      • kidney problems
      • headaches
      • tremors
      • nausea, diarrhea, abdominal discomfort
      • high blood sugar
      • high cholesterol
      • high potassium, low magnesium and phosphate

        To learn about side effects of other drugs used to treat GVHD, click here to order BMT InfoNet's free booklet Graft-versus-Host Disease: What to Know, What to Do.

        Clinical Trials/New Treatments for GVHD

        If current therapies are not controlling your graft-versus-host disease well, consider participating in a clinical trial. Clinical trials are carefully monitored research studies that test new drugs and therapies.

        Patients who participate in a clinical trial have early access to new medications, although there is no guarantee that the drugs being studied will be effective.

        Ask your doctor if there is a clinical trial that is appropriate for you. The Jason Carter Clinical Trials Program, operated by Be The Match®, can help you find a GVHD trial that you may want to consider. Visit the website, phone 888-814-8610 or email clinicaltrials@jcctp.org for more details.

        National Cancer Institute Chronic GVHD Program

        An important resource for people living with chronic GVHD is the National Cancer Institute's chronic GVHD program. Patients between the ages of one and 75 can schedule an appointment for a comprehensive evaluation of their GVHD.

        Specialists familiar with how chronic GVHD affects every part of a patient's body conduct the four-day physical examination, and make recommendations on how best to manage your disease.

        The medical evaluation is free of charge and takes place ata the National Cancer Institute in Bethesda, Maryland. The program is part of a clinical trial designed to gather a national database of information about chronic GVHD so that better treatments can be developed. For details email the NCI Study Team or phone 301-594-9336.

        Coping with the Stress of GVHD

        Living with GVHD can be an emotionally difficult experience for you and your family.  After transplant, everyone wants to resume a normal life, but GVHD can make that difficult for a time.

        It's normal to feel sad or anxious while dealing with GVHD.

        Physical changes, fatigue and drugs used to treat GVHD can cause:

        • depression
        • confusion
        • anxiety
        • mood swings
        • exaggerated feelings of anger, excitement or sadness
        • sleep problems

        It helps to remember that these side effects are temporary and will end when you are taken off the drugs. Some patients are prescribed medications to stabilize mood swings and reduce anxiety while they have GVHD. This is very common. Short-term use of these drugs does not mean you will be dependent on them long-term. Let your medical team know if you have had problems with alcohol or drug addiction in the past.

        Reach Out for Support

        If you have GVHD, it's important not to ignore or downplay your feelings. Finding an outlet to express your feelings can decrease your stress and help you forward in a healthy manner. This is true for both the patient and family caregiver.

        Talking with a therapist - a social worker, psychologist, psychiatrist or pastoral counselor - often helps. Therapists are trained to help you think about problems in different ways that help you take control of the problem, rather than letting the problem control you.

        It can also help to talk with others who have had GVHD to get support and insights into managing this challenging side effect. BMT InfoNet's Caring Connections Program can put you in touch with others who have experienced GVHD.

        Be The Match® offers free counseling for transplant patients and caregivers struggling with GVHD.  Phone 888-999-6743 or email patientinfo@nmdp.org for details.

        Your transplant center or local hospital may also be able to put you in touch with a local therapist who can help.

        If you prefer online support groups, BMT InfoNet's Facebook page - Bone Marrow and Stem Cell Transplant Club - can connect you with others dealing with GVHD. BMT InfoNet also offers some closed Facebook groups and periodic telephone support groups for GVHD patients and caregivers.  Phone 888-597-7674 or email help@bmtinfonet.org for details.

        You can't control how you feel, but can take steps to manage your feelings so that they don't disrupt your daily life.

        Exercise, Meditation and Relaxation

        People living with GVHD often find that meditation, guided imagery, relaxation programs and/or exercise helps them manage the physical and emotional effects of GVHD. Many hospitals offer these types of programs for patients. Community cancer wellness centers usually offer these as well.

        Some YMCAs have partnered with LIVESTRONG to offer cancer patients a free 12-week exercise program to help build endurance and reduce fatigue. Click here to find if a program is available near you.

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