Graft-versus-host disease

an early form called acute GVHD that occurs soon after the transplant when the white cells are on the rise, and a late form called chronic GVHD.

Acute GVHD typically occurs within the first three months after a transplant and can affect the skin, liver, stomach, and/or intestines. The earliest sign is usually a rash on the hand, feet, and face which may spread and look like a sunburn. Severe problems with acute GVHD may include blisters on the skin, watery or bloody diarrhea with cramping, and jaundice (yellowing of the skin and eyes) reflecting liver involvement.

Chronic GVHD typically occurs 2-3 months after the transplant and causes symptoms similar to those of autoimmune disorders such as lupus and scleroderma. Patients develop a dry, itchy rash, which is raised and like alligator skin. There also may be hair loss, decrease in sweating, and premature graying of the hair. Mouth dryness is a common symptom. It may progress to food sensitivity, such that spicy and acid foods may sting. The eyes may also be involved with dryness, irritation and redness. Almost any organ can be affected by chronic GVHD.

Prevention of severe GVHD includes elutriation (T-cell depletion), a technique in which the donor bone marrow is largely depleted of the T-cells that cause GVHD. Most patients also receive immunosuppressive drugs such as cyclosporine and methotrexate. Significant GVHD is usually treated with steroids and sometimes a drug called anti-thymocyte globulin.

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