For some patients diagnosed with blood cancers like lymphoma or leukemia, a stem cell transplant may be an effective treatment. However, one possible complication after a stem cell transplant is a condition called graft-versus-host disease (GVHD).
The two types of GVHD are:
Acute GVHD: This condition happens soon after a transplant and often requires early diagnosis and initiation of high dose steroids, with the majority of patients responding to steroids or approved second-line treatments.
Chronic GVHD: This condition develops later and may be mild, serious or even life-threatening.
“With modern regimens that limit chemotherapy toxicity, we’re able to offer stem cell transplants (HCT) to older and unfit patients, thereby increasing the utilization of HCT in patients with advanced hematologic malignancies,” says Amandeep Salhotra, MD, a blood cancer specialist and researcher at City of Hope® Cancer Center Duarte.
“With current preventive strategies, almost half of all patients, especially those who get unrelated donor transplants, will develop chronic GVHD, especially as we are transplanting older patients and using stem cells from unrelated donors. Current data suggest that unrelated transplants now exceed transplants from sibling donors and this trend will continue, due to demographic shifts toward small family sizes and not being able to find a sibling donor.”
Thankfully, there are both existing treatments for the condition and new therapies are on the horizon. This article covers the basics on GVHD, including:
- What is chronic GVHD?
- Acute versus chronic GVHD
- Chronic GVHD symptoms
- Chronic GVHD treatment
- How long does chronic graft versus host disease last?
If you’ve been diagnosed with cancer and would like to get a second opinion of your diagnosis or treatment options, call us or chat online with a member of our team.
What is chronic GVHD?
GVHD happens when new, transplanted stem and immune cells attack healthy cells in the recipient’s body.
Chronic GVHD is a condition that some patients develop after allogeneic stem cell transplantation. An allogeneic stem cell transplant is one in which a patient receives stem cells from a donor rather than from their own body, which is called an autologous stem cell transplant.
“We perform around 8,500 transplants in the United States per year, and 50 to 60 percent of those patients will develop some form of chronic GVHD,” says Dr. Salhotra.
Acute versus chronic GVHD
The main difference between the two types of GVHD is clinical presentation and how quickly symptoms appear after a transplant.
Acute GVHD usually occurs within 100 days of a stem cell transplant and presents with acute diarrhea, a skin rash or jaundice. Chronic GVHD usually occurs between 100 days and two years after a stem cell transplant with common symptoms including chronic dry eyes, mouth sores, skin or joint tightening and shortness of breath.
As acute or chronic GVHD can occur at any time after a stem cell transplant, blood cancer specialists diagnose acute or chronic GVHD based on what symptoms a patient has.
Chronic GVHD symptoms
Acute GVHD frequently causes issues such as diarrhea, a skin rash or elevated liver numbers.
The symptoms of chronic GVHD may affect more of the body’s organs. Some common chronic GVHD symptoms include:
- Skin rash, or a tightening of the skin
- Mouth dryness, sensitivity or sores
- Dry or painful eyes, or issues with your vision
- Liver health issues like jaundice
- Genital itching, pain or discomfort
- Lung problems, such as a cough or shortness of breath
- Joint stiffness or pain
According to Dr. Salhotra, “issues like chronic dry eyes, tightening of the skin and restriction in range of movement can be quite debilitating in patients, especially with more advanced forms of chronic GVHD involving multiple organs.”
Doctors at stem cell transplant centers like City of Hope ensure that patients who receive a transplant know which symptoms to look out for after their procedure.
“The important thing is that we detect it early and treat it aggressively, because once it becomes more established, then it's harder to reverse,” Dr. Salhotra adds.
Chronic GVHD treatment
The treatment a cancer care team recommends for chronic GVHD may depend on which parts of the body are affected. However, most patients are treated with a steroid medication called prednisone. If steroids do not help, doctors may turn to other options, explains Dr. Salhotra.
“Only half of patients who develop GVHD typically respond to steroids, however, there are approved therapies,” he says.
Several drugs for GVHD have been developed in part at City of Hope, including:
- Ibrutinib (Imbruvica®)
- Belumosudil (Rezurock®)
- Ruxolitinib (Jakafi®)
Each of these medications is taken by mouth and may limit the new stem/immune cells’ ability to attack health cells in a patient’s body.
Dr. Salhotra and his research team have also have helped developed a new drug for GVHD called axatilimab (Niktimvo™), which was just approved by the U.S. Food and Drug Administration.
“This medication is a monoclonal antibody that is given intravenously, every two weeks, and that targets a different kind of immune cell called the macrophages,” Dr. Salhotra says.
It is particularly effective for patients with advanced chronic GVHD or those who have multiple organ failure issues. While axatilimab won’t be available to every patient until early 2025, for City of Hope patients who have not responded to other treatments, there are programs that provide access to this drug, as well as other newly approved options and novel clinical trials.
How long does chronic graft versus host disease last?
While most cases of chronic GVHD are mild or moderate, for about one in 10 patients, the condition can be serious.
Most patients undergo some form of treatment for chronic GVHD for up to 5 years, while a small number of people may need to take medication for the disease for life.
“Severe forms of chronic GVHD can impact quality of life, patients’ ability to go back to work and their psychosocial health,” says Dr. Salhotra. This is in part why it is important that stem cell transplant patients receive high-quality care from a team of expert doctors with expertise in this post-transplant complication.
“At City of Hope, we have an established GVHD clinic staffed by hematologists, dermatologists, endocrine specialists, surgeons and other specialists,” he says. “This allows us to screen patients for how severe the disease is, and to offer clinical trials and standard of care treatments.”
If you’ve been diagnosed with cancer and would like to get a second opinion of your diagnosis or treatment options, call us or chat online with a member of our team.
