Bone marrow transplant

Graft-versus-host disease

Graft-versus-host disease (GVHD) is a common side effect in people who receive cells from a donor (allogeneic transplant). It occurs when the transplanted cells recognize the recipient’s tissues as foreign and attack the tissues. GVHD can cause a variety of problems, including skin rashes, diarrhea, and less frequently, liver problems.

Seattle Cancer Care Alliance (SCCA) has had a dedicated infrastructure for long-term transplant follow-up since the 1980s, and we are experts in treating people with GVHD. Our doctors have leading roles in the Consensus Conference on Clinical Practice in Chronic GVHD, and they help determine standard-of-care treatments in addition to designing and conducting clinical studies aimed at improving patient outcomes and preventing GVHD altogether.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Graft-versus-host disease A condition that occurs when donated stem cells or bone marrow (the graft) see the healthy tissues in the patient’s body (the host) as foreign and attack them. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

GVHD types

There are two types of GVHD:

  • Acute GVHD happens in the first three months after a transplant.
  • Chronic GVHD can develop any time between three months and three years after a transplant.

Both types of GVHD can range from mild to serious. Medications and other treatments that suppress the immune system are used to prevent and treat GVHD until the donor cells stop attacking—which they eventually do, sometimes within a few months but sometimes not for years.

GVHD care

People who have chronic graft-versus-host disease may need evaluations or care several times a year to assess and help manage their condition. Our GVHD experts provide these services through our Long-Term Follow-Up (LTFU) Program, which offers lifelong support, including direct care, to people who have had a transplant. The LTFU team will schedule clinic visits and design a GVHD treatment plan for you based on your individual needs. Visits take place in the LTFU Clinic on the 6th floor of the SCCA outpatient clinic on Lake Union.

Learn More About LTFU Program

New research to alleviate GVHD

Forty to 60 percent of allogeneic transplant recipients will get some form of GVHD. Thanks to clinical studies, a number of new drugs are available to treat it. SCCA has several clinical studies in progress working on ways to eliminate GVHD as a concern.

Post-transplant chemotherapy to prevent GVHD

SCCA transplant doctors have found that chemotherapy given after the donor cells are infused can kill off some of the immune cells, called T-cells, that cause GVHD. The expected rate of chronic GVHD is 45 percent, but with high-dose chemotherapy SCCA doctors can reduce the rate by half. They are also working to prevent GVHD by eliminating some T-cells from the donor cells before the cells are transplanted.

Statins to reduce GVHD

A study going on at SCCA uses statin drugs to reduce GVHD. These lipid-lowering drugs have an anti-inflammatory effect as well. Doctors have learned that if donors are taking statins before a transplant, the patient receiving the transplanted cells is much less likely to get severe, acute GVHD. Now SCCA doctors are looking at giving statins to patients two weeks before transplant to see if this will reduce the aggressiveness of the T-cells, thus reducing the likelihood of GVHD. 

Allogeneic stem cell transplant Uses bone marrow or stem cells from a related or unrelated donor whose tissue type closely matches the patient’s. Replaces blood-forming cells that have been destroyed by disease or cancer treatment. Uses bone marrow or stem cells from a donor whose tissue type closely matches the patient’s to replace blood-forming cells that have been destroyed by disease or cancer treatment. This can be from a related or unrelated donor. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Graft-versus-host disease A condition that occurs when donated stem cells or bone marrow (the graft) see the healthy tissues in the patient’s body (the host) as foreign and attack them. High-dose chemotherapy An intensive drug treatment to kill cancer cells. It also destroys bone marrow and can cause side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.