How GVHD is Treated

When you're working at a center with a group of GVHD clinicians who have a wide body of knowledge, you're able to offer educated approaches to try to manage each different symptom." Erin Kopp, Nurse Practitioner

Treatments for graft-versus-host disease (GVHD) may include:

  • Topical therapy (surface treatments) for mild cases
  • Steroids or systemic treatments (treatments that can affect the whole body)
  • Supportive care by a multidisciplinary team

Planning what will work best for you depends on several factors such as what organs are involved, the severity of GVHD, other health problems you may have, what drug interactions are taking place in your body and how much monitoring you will need with the treatment. Supportive care options often used along with systemic treatment for GVHD include:

 

Eyes

Supportive care for GVHD symptoms affecting the eyes includes:

  • Protect your eyes from intense sunlight by wearing glasses that block out the wind and help maintain moisture such as goggles and biking glasses.
  • Be aware of signs or symptoms of infection or worsening chronic GVHD, including redness, swelling, discharge and increasing pain or dryness.
  • Have routine eye exams to check for cataracts and increased pressure in the eye (intraocular pressure).
  • Report any vision changes to your health care provider right away.

 

Some possible treatment options for the eyes include:

  • Artificial tears, eye ointments
  • Ophthalmic inserts
  • Topical steroids
  • Cyclosporine eye drops
  • Plugging or heat cauterization of the lower tear ducts, possibly including upper ducts
  • Adding humidity to the home
  • Flax seed oil
  • Occlusive eye wear (glass that help maintain any moisture like goggles or biking glasses) or moisture chamber glasses
  • Drugs that may improve eye dryness
  • Tarsorrhaphy: partially sewing the eyelids together to narrow the opening
  • Autologous serum: eye drops made from your own blood
  • Topical antimicrobials

 

Vulva and vagina

Supportive care for GVHD symptoms affecting the vulva and vagina includes:

  • Look for and report signs and symptoms of excessive vaginal dryiness, painful red lesions (such as herpes simplex virus), vaginal warts from human papillomavirus, and unsual discharge that can be seen with yeast and bacterial infections.
  • Report to your doctor or nurse difficulties or pain with vaginal intercourse. Excessive vaginal dryness may be a sign of low estrogen levels, and this can be tested for and treated by your health care provider.

 

Some possible treatment options for the vagina and vulva include:

  • Early gynecology consultation
  • Water-based lubricants
  • Topical estrogen, topical corticosteroids or calcineurin inhibitors
  • Dilators to gently open or dilate a narrowed vaginal cavity
  • Surgery for extensive structural or functional changes

 

Gastrointestinal tract and liver

  • Look for signs and symptoms of yellow jaundice, weight loss or changes in bowel habits.

Some possible treatment options for the liver and GI tract include:

  • Diet changes
  • Adding enzymes to help with malabsorption
  • Using medicines to manage gastrointestinal reflux
  • Esophageal dilation
  • Ursodoxycholate to improve flow of bile salts to the liver

 

Lungs

  • Look for signs of infection, including cough, fever, green or yellow phlegm or shortness of breath.
  • Pulmonary function tests (PFT) are very important. They may show problems before symptoms arise. PFTs help find chronic GVHD of the lung early, which can be very helpful.

 

Some possible treatment options for the lungs include:

  • Inhaled steroids and bronchodilators
  • Pulmonary rehabilitation

 

Musculoskeletal

  • Look for signs and symptoms of stiffness and limited range of motion of joints such as knees ankles, shoulders, elbows and wrists.
  • Ask your health care provider if you need bone density testing.
  • Ask your health care provider to check your calcium levels and 25-OH Vitamin D level.
  • If ordered, take part in physical therapy.
  • Ask your health care provider if you need to take calcium and vitamin D supplements each day.

 

Some possible treatment options for musculoskeletal problems include:

  • Physical therapy to help with strength and joint movement
  • Weight-bearing exercise 30 minutes a day at least five days a week
  • Stretching
  • Deep tisssue massage for hardening of the skin (scleroderma) or fasciitis
  • Bisphonate medicines for osteopenia and osteoporosis

 

Neurologic

  • Ask about lab work to watch cyclosporine or tacrolimus levels in the blood.
  • Prevent seizures by controlling blood pressure, replacing electrolytes, and taking anti-seizure medicines, if needed.

 

Some possible treatment options for neurologic problems include:

  • Occupational and physical therapy
  • Medicines to treat depression, seizures or chronic pain, if needed

 

Used With the Permission of: Mary E.D. Flowers, M.D., and Kenneth R. Cooke, M,D,. and the National Bone Marrow Transplant Link

What should I do if I think I may have GVHD?

Tell your doctor about any changes right away.  It is important to detect GVHD early in order to begin therapy, and prevent more serious complications. Goals for managing GVHD include early medical care to control symptoms and prevent organ damage. Close communication between the patient, caregivers and health care team is very important.  

Not all health problems you experience will be caused by GVHD.  If you see or feel any of the above symptoms, your health care team may do some tests to find out the issue is GVHD or not, so that they can provide the proper care.

 

For more information, please see the booklet, "Graft-versus-Host Disease, Living with the After Effects of Bone Marrow/Stem Cell Transplant." Stop by the Sheri & Les Biller Patient and Family Resource Center to request a copy, or visit the National Bone Marrow Transplant Link for a copy of the book, "Graft-versus-Host Disease."