There are two manifestations of GVHD - acute and chronic. Although both forms can affect the skin, liver and gut, the mechanisms are different. The chronic presentation can spread to many additional organs so treatment is handled differently to the acute manifestation of the disease.
Treating acute GVHD
Immunosuppressive therapy is used to treat acute GVHD. These drugs counter the attacks by the graft T-cells, which view the host cells as foreign. The patient may need to take corticosteroids, such as prednisolone. Steroids are used to try to help bring the patient’s immune system back into control and minimise inflammation. However, steroids can cause side effects such as higher levels of blood sugar, fluid retention, mood problems, a greater appetite and stomach pain. Long-terms use of steroids has been linked to diabetes, muscle weakness, infections and cancers.
Skin symptoms – the patient may initially use a steroid cream for the rash that develops in the early and mild stages of the disease. As the skin condition becomes more severe, the doctor may switch the treatment to tablets. If the patient has the most severe grade of GVHD, steroids can be administered through a drip.
The patient should also take steps to not to irritate the skin further. This can include choosing to wear cotton clothing, avoiding using hot water and perfumed substances on the rash and keeping out of the sun.
Gastrointestinal symptoms – the primary treatment for the patient is steroids, but other medicines can be used to alleviate the discomfort of others symptoms. Painkillers can help ease stomach pains. The patients may also need to stay hydrated through a drip and a feeding tube may be necessary. Any foods and/or drinks that irritate the stomach should also be avoided. These include peppery foods and alcohol.
Liver symptoms – steroids may also be used to treat liver complications such as jaundice associated with GVHD. However, a blood transfusion may be needed if blood cell count and platelet levels fall very low. Liver function tests are performed periodically to monitor response to therapy.
Skin symptoms – the treatment for the skin in the chronic presentation of GVHD is similar to the acute version. The primary agents used are steroids and the patient is also encouraged to stay away from perfumed products or fabrics that can make the irritation worse. Moreover, they are advised to lubricate the skin as much as possible and stay away from hot water. Sun protection is advised and the patient needs to avoid rubbing the skin.
GI symptoms – as well as steroid treatments, the patient should try to stay hydrated, especially if they have complications such as diarrhea. The chronic version of the disease can affect all GI regions right up to the mouth. Mouth washes are encouraged if any infections or sores develop in this region.
Eye symptoms – the patient’s eyes can stop producing tears and become dry and irritated with chronic GVHD. Eye drops can help to alleviate these symptoms. The immunosuppressant drug cyclosporine can also be used in the eyes. Consultation with an optician may be necessary for some patients.
Genital symptoms – steroid cream can be applied by the patient to deal with dryness and irritation in this area.
Lung symptoms – steroids are the first drugs of choice for complications in the lungs. The patient can develop coughing, wheezing and chest infections, which the doctor may wish to treat with antibiotics. In severe cases, oxygen therapy may be required.
Reviewed by Jonas Wilson, Ing. Med.