Graft Versus Host Disease (GVHD) Treatment

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

Treatments for graft versus host disease (GVHD) may depend on the stage and grade of the condition, as well as the location of the GVHD symptoms. 

Treatment for Graft vs. Host Disease

Planning what will work best for each patient depends on several factors, such as which organs are involved, the severity of GVHD, other health problems the patient may have, which drug interactions are taking place and how much monitoring the patient will need with the treatment. 

Options for treating both acute and chronic GVHD may include those listed below.

Topical therapy (surface treatments): This may include a steroid cream or other therapies that can be applied to the skin and is typically used for mild cases of GVHD. 

Systemic steroids: Steroid therapy is referred to as “systemic” if it affects the entire body. These drugs may include prednisolone, methylprednisolone or other options. 

Secondary therapies: If the patient doesn’t respond to steroid therapy, the care team may use other medications that are given orally or administered intravenously. The specific drug used depends on where the symptoms are occurring. 

Supportive care: The care team may recommend supportive care therapies to help ease GVHD symptoms.

GVHD Eye Treatments

Supportive care for GVHD symptoms affecting the eyes includes those listed below.

• Protecting the patient's eyes from intense sunlight by wearing glasses that block out the wind and help maintain moisture such as goggles and biking glasses
• Being aware of signs or symptoms of infection or worsening chronic GVHD, including redness, swelling, discharge and increasing pain or dryness
• Having routine eye exams to check for cataracts and increased pressure in the eye (intraocular pressure)
• Reporting any vision changes to the care team right away
• Using artificial tears or eye ointments, consuming flaxseeds and adding humidity to the home to relieve dryness or other symptoms

Some possible treatment options for the eyes include:

• Ophthalmic inserts
• Topical steroids
• Cyclosporine eye drops
• Plugging or heat cauterization of the lower tear ducts, possibly including upper ducts
• Occlusive eyewear (glass that helps 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 the patient's own blood)
• Topical antimicrobials

Vaginal GVHD Treatment

Supportive care for GVHD symptoms affecting the vulva and vagina includes those listed below.

• Reporting signs and symptoms of excessive vaginal dryness, painful red lesions (such as herpes simplex virus), vaginal warts from human papillomavirus or unusual discharge that can be seen with yeast and bacterial infections
• Reporting difficulties or pain with vaginal intercourse to the care team, since excessive vaginal dryness may be a sign of low estrogen levels, and this can be tested for and treated by the care team
• Using water-based lubricants to alleviate vaginal dryness

Some possible treatment options for the vagina and vulva include:

• Topical estrogen, topical corticosteroids or calcineurin inhibitors
• Dilators to gently open or dilate a narrowed vaginal cavity
• Surgery for extensive structural or functional changes

Treating GVHD of the Gastrointestinal (GI) Tract and Liver

Supportive care for GVHD symptoms affecting the GI tract includes:

• Changing the patient's diet to only include foods that don't exacerbate symptoms
• Adding enzymes to the patient's GI tract to help with malabsorption

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

• Using medicines to manage gastrointestinal reflux
• Esophageal dilation
• Ursodoxycholate to improve the flow of bile salts to the liver

Treating GVHD of the Lungs

Supportive care for GVHD symptoms affecting the lungs includes:

• Looking for signs of infection, including cough, fever, green or yellow phlegm or shortness of breath
• Seeing the care team for periodic pulmonary function tests (PFTs), which may show problems before symptoms arise and can be used to help find chronic GVHD of the lung early

Some possible treatment options for GVHD of the lungs include:

• Inhaled steroids and bronchodilators
• Pulmonary rehabilitation

Musculoskeletal GVHD Treatments

Supportive care for GVHD symptoms affecting the musculoskeletal system includes:

• Looking for signs and symptoms of stiffness and limited range of motion of joints, such as knees ankles, shoulders, elbows and wrists
• Talking to the care team about whether bone density testing, calcium level monitoring or 25-OH Vitamin D level monitoring are necessary
• Participating in physical therapy, when warranted
• Taking calcium and vitamin D supplements each day, if recommended by the care team
• Stretching and performing weight-bearing exercises for 30 minutes a day at least five days a week
• Getting a deep-tissue massage for hardening of the skin (scleroderma) or fasciitis

Some possible treatment options for musculoskeletal problems include bisphonate medicines for osteopenia and osteoporosis.

Neurologic GVHD Treatments

Supportive care for GVHD symptoms affecting the neurologic system includes:

• Talking to the care team about whether it's a good idea to monitor cyclosporine or tacrolimus levels in the blood
• Controlling blood pressure, replacing electrolytes and taking anti-seizure medicines, if needed, to prevent seizures
• Talking to an occupational or physical therapist about whether therapy might help the patient prevent or manage symptoms

Some possible treatment options for neurologic problems include medicines to treat depression, seizures or chronic pain, if needed.

Get advice on managing the emotional impact of chronic GVHD.