Graft-versus-host disease (GVHD) is a dangerous, potentially fatal side effect that can occur after allogeneic stem cell transplantation. It occurs when T cells – a type of disease-fighting white blood cell – that are transferred along with the donated stem cells stage an immune response to the “foreign” antigens expressed on tissues of most organs in the patient’s body. The T cells attack the patient’s body. GVHD mainly affects the skin, gastrointestinal tract, liver, eyes, and oral mucosa. Symptoms reflect which area of the body is affected:
- Skin: Rash or itching of the chest, upper back, trunk, palms, and soles of the feet
- Gastrointestinal Tract: Profuse diarrhea, anorexia, nausea, vomiting
- Liver: Yellowing of the skin and whites of the eyes (jaundice), increased liver enzymes
- Eyes: Severe dryness of the eyes, sensitivity to light, problems with the retina or cornea
- Oral Mucosa: Ulcerations in the mouth
To guard against GVHD, you will be given prophylactic immunosuppressive medications (called immunosuppressants or steroids) before your transplant and after. These medications suppress the immune response and can include tacrolimus (Prograf), cyclosporine, and low doses of methotrexate. Should you develop GVHD, the primary therapy is to adjust the dosages of tacrolimus or cyclosporine to reduce the immune response or to add methylprednisolone, another immunosuppressant to your medications. Anti-Thymocyte Globulin (ATG) may be given before the transplant or after discharge from the hospital. Secondary treatments include the immunosuppressant pentostatin or monoclonal antibodies for patients whose GVHD does not respond to steroids.
Changes in the dosages of immunosuppressants should improve symptoms of GVHD. Other therapies may include a special GVHD diet to reduce inflammation in the gastrointestinal tract or eye solutions to add moisture to the eyes. You should visit an ophthalmologist, a specialist in diseases of the eye, to check for problems with your retinas.
At The Cancer Center, basic science researcher Robert Korngold, Ph.D., is among the leading researchers in the country in GVHD. They are conducting studies to learn more about the basic biology of GVHD and what can be done to eliminate or diminish the risk of GVHD in stem cell transplant patients. Our researchers are responsible for some of the major discoveries in this field in the past 25 years, including the fact that T cells cause GVHD. This groundbreaking research and other studies have led to improvements in the stem cell transplantation process. Their research is funded by the National Institutes of Health’s National Institute for Allergy and Infectious Diseases and its National Heart, Lung, and Institute and the Multiple Myeloma Research Foundation.
An innovative therapy for GVHD is under investigation in clinical trials by Michele L. Donato, M.D., medical director of the blood and marrow collection facility. Dr. Donato is studying the use of photopheresis to treat autoimmune disorders, including GVHD in patients who have undergone stem cell transplantation. Photopheresis involves isolating T cells from the patient’s body, treating them with medications, and then exposing them to ultraviolet light. These engineered T cells are then reinfused back into the patient’s body. The treated T cells temper the immune system, without weakening it, and prevent it from being too aggressive toward the donated stem cells.