What is Graft-Versus-Host Disease (GVHD) after stem cell or bone marrow transplantation?

Graft-Versus-Host Disease (GVHD) is a potential and serious complication that can arise after a stem cell or bone marrow transplant. This condition occurs exclusively in "allogeneic" transplants, where the patient receives stem cells from a donor; it does not occur in autologous transplants (using the patient's own cells) [4]. In this scenario, immune cells from the donor recognize the patient's body tissues as foreign and begin to attack them, leading to a variety of inflammatory symptoms [2].

How does the graft attack the patient's body?

Allogeneic bone marrow transplantation is performed to replace the patient's damaged cells with healthy ones from a donor. Before the transplant, the patient undergoes treatments designed to suppress their immune system to reduce the risk of the body rejecting the transplanted cells. However, the active nature of the donor's immune cells may lead them to view the recipient's organs and tissues as unfamiliar foreign bodies, triggering an immune attack against these healthy tissues [4]. The likelihood and severity of the condition depend on the degree of tissue matching between the donor and the patient; the closer the match, the lower the risk of this immune reaction occurring [4].

The difference between acute and chronic Graft-Versus-Host Disease

Doctors classify this disease into two main types based on the timing of symptom onset and the nature of the immune attack:

• Acute Graft-Versus-Host Disease: This typically appears within days or up to 6 months after the transplant. This type primarily targets the skin, liver, and digestive tract. Common symptoms include abdominal pain or cramping, nausea, vomiting, diarrhea, skin rash or redness, as well as jaundice (yellowing of the skin or eyes) resulting from impaired liver function [4].
• Chronic Graft-Versus-Host Disease: This type usually appears more than 3 months after the transplant and can persist for long periods. Symptoms are diverse and may include dry eyes or mouth, vision changes, white patches inside the mouth, skin changes such as thickening or tightness, joint pain, shortness of breath, and general weakness [4].

Practical steps and medical follow-up

If you have undergone a bone marrow transplant, it is essential to be vigilant for any unusual symptoms. Diagnosing this condition requires precise tests, including liver function tests, imaging, and possibly a skin or mucosal biopsy to confirm the diagnosis. Treatment is primarily based on immunosuppressive drugs, such as corticosteroids, to reduce the attack by the transplanted cells, in addition to the emergence of modern targeted therapies for this disease [4].

Always remember that immediate communication with your healthcare team is the most important step if you notice any symptoms suggesting GVHD or any unusual complications following the transplant. Do not ignore any symptoms, as early intervention significantly contributes to improving therapeutic outcomes [4]. To learn more about this medical procedure, you can view our article on Bone marrow transplantation for non-cancer diseases (Arabic).

Medical references

• Treatments for Blood Disorders Treatments for Blood Disorders
• Graft-versus-host disease: MedlinePlus Medical Encyclopedia