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.

8-MOP (see methoxsalen)

8-methoxypsoralen (see methoxsalen)

Abatacept (Orencia®)

• headache
• infection
• nausea
• infusion reactions, such as chills and fevers

Afintor® (see everolimus)

Alemtuzumab (Campath®)

• infusion reactions: rigors, fever, chills, skin rash
• nausea, vomiting, diarrhea
• low blood cell counts
• difficulty breathing, cough
• infections: pneumonia, herpes simplex, sepsis
• headache, bone and muscle pain
• high blood pressure, rapid heart rate

Antithymocyte Globulin (ATGAM, Thymoglobulin®)

• 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

ATGAM (see anti-thymocyte globulin)

Autologous serum eye drops

• worsening of eye discomfort 
• bacterial conjunctivitis 
• redness of the eyelids 
• corneal damage

Azathioprine (Imuran®)

•  low white blood cell count
•  infections

Azithromycin 

• diarrhea and loose stool
• nausea
• abdominal pain
• cramping

Belumosudil (Rezurock®)

• infection
•  weakness
• nausea, diarrhea
• shortness of breath, cough
• low white blood cell count
• abnormal blood test for thyroid function
• swelling caused by excess fluid
• bleeding
• muscle, bone, tendon or nerve pain
• stomach pain
• high blood pressure
• abnormal blood test results for liver function
• headache, fever
• muscle spasm, joint pain
• decreased appetite, difficulty swallowing
• skin rash, dry skin
• nasal congestion
• calcium in blood
• anemia

Bortezomib (Velcade®)

• numbness, tingling on hands and feet (peripheral neuropathy)
• nerve pain
• burning, prickling sensation on skin, skin rash
• constipation, nausea, diarrhea, vomiting
• dizziness
• lack of appetite, weight loss, stomach pain
• low blood cell counts
• weakness, lack of energy
• shortness of breath
• headache

Campath® (see alemtuzumab)

CellCept® (see mycophenolate mofetil)

Cyclophosphamide 

• nausea, vomiting, diarrhea
• mouth sores
• kidney problems
• bleeding from bladder
• bloody urine
• low blood cell counts 
• infections

Cyclosporine (Gengraf®, Neoral®, Sandimmune®) 

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

Daclizumab (Zenapax®)

• immune system disorders
• throat and nose infection
• skin reactions, rash

Denileukin diftitox (Ontak®)

• flu-like symptoms, fever, chills, headache
•  liver enzyme elevation
• infections
• nausea, vomiting, diarrhea
• low blood pressure
• cough
• low calcium, low albumin  
• difficulty breathing, chest pain, increased heart rate
• bloody urine

ECP (see extracorporeal photopheresis)

Enbrel® (see etanercept)

Etanercept (Enbrel®)

• respiratory infections
• reactions at the site of injection
• headache

Everolimus (Afinitor®)

• constipation
• slowly healing wounds
• nausea, vomiting, diarrhea
• anemia
• urinary tract infection, pain when urinating, blood in urine
• other infections
• high blood pressure
• headache
• swelling due to fluid retention
• endocrine problems
• abnormal kidney function test
• stomach pain
• fever
• fatigue
• difficulty sleeping
• back and limb pain
• low white blood cell count

Extracorporeal Photopheresis (ECP)

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

Gengraf® (see cyclosporine)

Gleevec® (see Imatinib mesylate)

Ibrutinib (Imbruvica®)

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

IL-2 (see interleukin-2)

Imatinib mesylate (Gleevec®)

• nausea, vomiting, diarrhea, abdominal pain
• muscle cramps, muscle pain, joint pain 
• swelling, weight gain 
• low blood counts 
• liver inflammation 
• infections 
• rash

Imbruvica® (see ibrutinib)

Imuran® (see azathioprine)

Infliximab (Remicade®)

• infections
• nausea
• infusion reactions
• diarrhea
• liver enzyme abnormalities

Interleukin-2 (IL-2, Proleukin®)

• 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

Jakafi® (see ruxolitinib)

Methotrexate (Rheumatrex®)

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

Methoxsalen (Oxsoralen®, 8-MOP, 8-methoxypsoralen) with ultraviolet A light

• nausea
• itching of the skin 
• sensitivity to the sun

Montelukast (Singulair®)

• headache

Muromonab-CD3 (Orthoclone®, OKT3)

• fever, chills
• breathing difficulty, wheezing
• chest pain
• nausea, vomiting, diarrhea
• tremor
• headache

Mycophenolate mofetil (MMF, CellCept®) 

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

Myfortic® (see mycophenolate mofetil)

Neoral® (see cyclosporine)

Nipent® (see pentostatin)

OKT3 (see Muromonab-CD3)

Ontak® (see Denileukin diftitox)

Orencia® (See abatacept)

Orthoclone® (see Muromonab-CD3)

Oxsoralen® (see methoxsalen)

Pentostatin (Nipent®)

• nausea, vomiting, diarrhea
• rash
• fatigue
• fever, chills
• infections
• neurological toxicity
• muscle pain
• low white blood cell count

Pomalidomide (Pomalyst®)

• fatigue
• weakness
• low white blood cell count
• anemia
• constipation
• nausea
• diarrhea
• shortness of breath
• upper respiratory infections
• back pain
• fever
• neuropathy (numbness and tingling)
• dizziness
• confusion
• skin rash
• tremors
• myalgia/muscle cramps
• blood clots

Pomalyst® (see pomalidomide)

Prednisone and Prednisolone

• 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

Prograf® (see tacrolimus)

Proleukin® (see interleukin-2)

Psoralen with ultraviolet A light

• nausea
• itching of the skin

PUVA (see psoralen with ultraviolet A light)

Rapamune® (see sirolimus)

Remicade® (see infliximab)

Rezurock® (see belumosudil)

Rheumatrex® (see methotrexate)

Rituximab (Rituxan®)

• infusion reactions: fever, chills, rigors, low blood pressure 
• rash, itching skin
• swelling of soft tissues 
• infections
• muscle pain
• diarrhea, nausea, vomiting
• low blood counts 
• low immunoglobulin levels
• reactivation of hepatitis B

Rituxan® (see rituximab)

Ruxolitinib (Jakafi®)

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

Sandimmune® (see cyclosporine)

Singulair® (see Montelukast)

Sirolimus (Rapamune®)

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

Tacrolimus (Prograf®)

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

Thymoglobulin® (see antithymocyte globulin)

• headache, dizziness
• nausea, vomiting, gastric discomfort
• back pain
• respiratory infection

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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.

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