Graft Versus Host Disease (GVHD)

September 27, 2024
This page was reviewed under our medical and editorial policy by Leslie Popplewell, M.D., Hematologist and Medical Director of Hematology and Blood and Bone Marrow Transplant, City of Hope^® Atlanta

Graft versus host disease (GVHD) is a long-term side effect that occurs in about half of allogeneic stem cell transplant patients.

What Is GVHD?

Graft versus host disease occurs when the donor’s stem cells, called T lymphocytes, do not recognize the recipient’s cells and attack them.

When the care team evaluates who might be a suitable stem cell donor for the patient, they look closely at each person's human leukocyte antigen (HLA) type during a process called tissue typing. The closer the HLA match, the better the chance the patient won't develop GVHD.

If GVHD does occur, it can range from mild to severe. Mild GVHD can be helpful because it has anti-cancer effects and patients with mild GVHD tend to have the best outcomes.

Types

There are two types of GVHD: acute and chronic.

Acute Graft Versus Host Disease

Acute GVHD is most likely to develop during the 100 days after transplant. These GVHD symptoms tend to appear quickly in the first three months. This type of graft versus host disease affects 30% to 70% of transplant patients.

The risk of developing acute GVHD is higher in patients with:

• Get their stem cells from unrelated donors or donors who aren't perfect HLA matches
• Are older
• Don't have the same gender as their donor
• Received peripheral stem cells

Chronic Graft Versus Host Disease

Chronic GVHD (cGVHD) symptoms show up slowly, typically between two and 24 months after transplant. Treatment of cGVHD can take two to three years and, in most cases, patients recover after five years. In some cases, symptoms will show quickly (acute) and last for several years (chronic).

The risk of developing chronic GVHD is higher in patients who:

• Get their stem cells from unrelated donors or donors who aren't perfect HLA matches
• Are older
• Don't have the same gender as their donor
• Received peripheral stem cells 
• Previously experienced acute GVHD

GVHD Diagnosis and Testing

If the patient has any signs of GVHD, the care team will perform a series of tests to rule out other conditions that may be causing these symptoms or to confirm the presence of GVHD. Tests may include: 

Biopsy: Depending on where the symptoms are occurring, the provider may take a tissue sample and examine it in a lab. For instance, patients with skin symptoms may need a skin biopsy. 

Blood tests: The care team may order blood testing to determine whether certain markers in the blood are at abnormal levels. 

Endoscopy: If the care team believes GVHD may be affecting the esophagus, stomach or other gastrointestinal organs, they may perform an endoscopy to examine them. 

Imaging tests: The care team may order an X-ray, computed tomography (CT) scan, ultrasound or other imaging tests to look for signs of GVHD in organs such as the lungs or liver.

GVHD Stages

If a patient has acute GVHD, the care team will stage each affected organ using a stage ranging from 1 to 4: 

• Stage 1 GVHD: Symptoms are mild. 
• Stage 2 GVHD: Symptoms are moderate. 
• Stage 3 GVHD: Symptoms are severe. 
• Stage 4 GVHD: Symptoms are very severe. 

After the organs are staged individually, the care team will assign an overall GVHD grade, ranging from 1 (the mildest grade) to 4 (the most severe grade). 

Can Graft vs. Host Disease Be Prevented? 

Medications, called immunosuppressants, are given before, during and after transplants to prevent, suppress and minimize the risk of GVHD. However, graft versus host disease may develop despite the administration of these drugs. That’s why it’s important to report any symptoms to the care team. They can help the patient develop a GVHD treatment plan customized to his or her symptoms, severity, overall health and other factors.