Chronic Graft-Versus-Host Disease

Definition

Chronic graft-versus-host disease (chronic GvHD) is a condition that can develop after someone receives a bone marrow or stem cell transplant. 

In chronic GvHD, donor immune cells trigger the transplant recipient’s immune system to attack their own tissues and organs. This causes inflammation and damage in many parts of the body. 

Chronic GvHD is common. Up to about 40% of people develop chronic GvHD after a bone marrow or stem cell transplant. Chronic GvHD usually starts within the first year after a transplant. But it may also develop later.

Chronic GvHD isn’t the same as acute graft-versus-host disease (acute GvHD). But many people develop both. In fact, most people who develop chronic GvHD have a history of acute GvHD. But you can still develop chronic GvHD even if you’ve never experienced acute GvHD. 

Symptoms

Symptoms of chronic GvHD vary from person to person. Chronic GvHD can lead to symptoms like:

• Eye pain, dryness, and vision changes 

• Dry mouth, mouth sores, and gum disease

• Throat pain and trouble swallowing

• Skin rashes and sores

• Hair and nail changes

• Diarrhea, nausea, and stomach pain

• Weight loss

• Trouble breathing

• Muscle pain and weakness

• Joint stiffness

• Trouble having sex and painful intercourse

Chronic GvHD symptoms may be mild at first. But they get worse over time as inflammation leads to organ damage. 

Spotting symptoms early can be lifesaving. It means you can start treatment faster. And starting treatment quickly means you can keep symptoms from getting worse and stop organ damage.

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Diagnosis

Spotting your symptoms is the key to getting a chronic GvHD diagnosis. Contact your transplant team if you think you’re experiencing chronic GvHD symptoms, even if those symptoms are mild. Share your symptoms and timeline with your transplant team. 

From there, you’ll need additional tests to confirm a chronic GvHD diagnosis. This can include:

• A physical exam

• Blood tests

• Skin biopsy

• Upper endoscopy 

• Pulmonary function tests

• Imaging tests (X-rays, CT scans, ultrasounds)

You may need some or all of these tests, depending on your symptoms. 

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Medication

Chronic GvHD medications suppress the immune system so it stops attacking your body. The right treatment plan will be different from person to person. Your treatment plan will depend on your symptoms and how chronic GvHD is affecting your body. You will work with your transplant team to choose the best options. 

Treatments could include:

• Steroid creams and inhalers

• Oral steroids (prednisone)

• Procedures like extracorporeal photopheresis 

• Medications like Imbruvica (ibrutinib), Rezurock (belumosudil), Jakafi (ruxolitinib), or axatilimab

There are many other medications that can help to calm the immune system if these medications aren’t enough. 

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Treatments

Calming the immune system will stop any further damage to your body and stop your symptoms from getting worse. But treatment can’t undo any damage that has already been done. Your body may recover over time. But some people develop life-long symptoms. 

There are also treatments that can help ease these symptoms. These treatments can’t cure chronic GvHD, but they can make you more comfortable. Some options for treating chronic GvHD symptoms include:

• Physical therapy to help with muscle and joint stiffness

• Emollients and other skin creams to help with rashes

• Artificial tears, punctal plugs, and prescription eye drops to relieve dry eyes

• Prescription medications to ease dry mouth and painful swallowing

• Hormone replacement therapy and lubricants to ease genital symptoms

Your transplant team will have suggestions for treatment options that can ease your symptoms. Many people also learn about options from support groups and other people who have lived with chronic GvHD.