Acute Graft-versus-Host Disease Symptoms and Treatment

Acute GVHD typically occurs during the first three months after transplant although it can also occur later, such as when immunosuppressive medicines are being tapered down.

Factors that increase the risk of developing acute GVHD include:

• total body irradiation given prior to transplant
• advanced patient and donor age
• how well matched the donor is for the patient

Preventing Acute GVHD

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

• cyclosporine 
• tacrolimus 
• methotrexate
• mycophenolate mofetil 
• sirolimus
• cyclophosphamide
• antithymocyte globulin 
• abatacept

These drugs suppress the donor's immune system which has been transplanted into you, 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 the transplant and, in some cases, for life. 

Recently, doctors have found that giving patients a chemotherapy drug called cyclophosphamide (Cytoxan®) a few days after transplant significantly reduces the likelihood of developing acute and chronic GVHD. This strategy is increasingly being used at many transplant centers.

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.

T-cells are a type of white blood cell. They protect the body from infection and fight cancer, but they can also cause GVHD.

Symptoms of Acute GVHD

Skin is often affected by acute GVHD. It may start as a faint rash that can be itchy. The rash may appear on the:

• back, shoulders, ears, or neck
• chest or abdomen
• legs or arms
• palms of the hands or soles of the feet

It typically resembles a heat rash, but in severe forms it may look like a sunburn with blisters. The rash usually starts on a small area of skin and often spreads to more areas.

Acute GVHD can also affect the gastrointestinal tract, causing:

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

Sometimes  acute GVHD affects the liver causing:

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

Treatment for Acute GVHD

If you develop acute GVHD, steroids such as prednisone or methylprednisolone may help control the disease. Steroids can cause unpleasant side effects. Go to our page about steroids to learn more about potential side effects of steroids.

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

• ruxolitinib
• antithymocyte globulin
• sirolimus
• mycophenolate mofetil
• extracorporeal photopheresis

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

Once it appears that your acute GVHD is under control, your doctor will start tapering down the dosage of steroids or other drugs. It’s possible, however, for acute GVHD to return or get worse during the tapering process. You may need to continue the medication longer until the disease is no longer active.

Take Action!

Tell your transplant 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 additional, serious complications.

Next Page: Chronic GVHD Symptoms and Treatment