Drugs and medicines to treat GvHD
There are different medicines you might have to treat graft versus host disease (GvHD). Find out about these on this page. We also explain a little about how they work.
There are 2 main types of GvHD. They are:
- acute GvHD
- chronic GvHD
Acute GvHD generally starts within 100 days of your transplant, but it can sometimes happen after this time.
Chronic GvHD generally starts from as early as 3 months to 2 years after your transplant. However it is possible for it to start earlier.
How these medicines work
Most of these medicines work by dampening down (suppressing) your 
. This stops the donated cells, also called the graft, from attacking your body. Your body is also called the host.
You are at a greater risk of getting an infection if you have GvHD, because it weakens your immune system. Treatments for GvHD increase this risk further.
Your doctor and nurses will keep a close eye on you. Tell them if you notice any signs of infection so you can start any necessary treatment.
Medicines to treat GvHD
The medicines you take for GvHD depend on where it is and how severe it is. You and your healthcare team decide on the best type of treatment for you.
Steroids
Steroids are usually your first treatment for GvHD. They are also the most common GvHD treatment.
Steroids suppress your immune response and reduce inflammation.
Types of steroids for GvHD include:
- prednisolone - you take this by mouth
- methylprednisolone - you have this as a drip into the bloodstream (intravenously)
- steroid creams – you apply them directly to the skin
- steroid eye drops for GvHD affecting the eye
- budesonide for GvHD of the digestive system
- steroid inhalers for GvHD of the lungs
Once your GvHD is under control your doctor will gradually reduce the dose. You might have steroids on their own or with other treatments listed on this page.
Some of the side effects of steroids include:
- changes to your blood sugar levels
- mood changes such as feeling anxious or more emotional than usual
- increased appetite
- weight gain
- difficulty sleeping
- changes to your face and appearance such as a swollen or puffy face, stretch marks, acne and increased facial hair
- fluid build up (oedema)
Calcineurin inhibitors (ciclosporin or tacrolimus)
These medicines block the protein calcineurin. This protein is important in causing the immune system to release into the body. When this protein is blocked it stops an . This helps treat the GvHD and stop it getting worse.
Ciclosporin and tacrolimus are types of calcineurin inhibitors. You might have one with other medicines such as .
They both come in different forms, so you might have them:
- by mouth - as a capsule, tablet or as a liquid that you drink
- as eye drops
- as a drip into your bloodstream (intravenously)
- directly onto the skin as a cream or ointment to the affected area
Some of the common side effects for both of these medicines include:
- feeling sick
- high blood pressure
- shaking of your body that you can’t control (tremor)
- headaches
- kidney problems
Some other common side effects of ciclosporin include:
- excess growth of body and facial hair in women (hirsutism)
- high levels of fat (lipid) in the blood
Other common side effects of tacrolimus include:
- high blood sugar
diabetes - a high level of potassium in your blood
- difficulty in sleeping or staying asleep (insomnia)
diarrhoea liver problems picked up on blood tests
Avoid grapefruit or grapefruit juice. This is because it can interfere with how these drugs work.
You will have regular blood tests to check for side effects to your kidneys or liver.
Mycophenolate mofetil (MMF)
Mycophenolate mofetil is also known as CellCept. It is another medicine that doctors use to dampen down your immune system. You take it by mouth as a tablet, capsule or liquid.
The main side effects are diarrhoea, sickness and a higher risk of infections. This is because it lowers your white blood count.
Chemotherapy
You usually have chemotherapy to kill cancer cells. It works by killing cells that are in the process of dividing into two. Doctors sometimes use chemotherapy to help prevent and treat GvHD. It works by killing T cells.
Methotrexate is a type of chemotherapy. You might have low doses of methotrexate after your transplant to try to prevent GvHD.
This medicine puts you at a higher risk of infections. So, as with GvHD generally, look out for any signs of infection and report them immediately to your doctor.
Monoclonal antibodies (mAbs)
Monoclonal antibodies are made in the laboratory and are designed to target specific proteins on the surface of cells. You usually have them through a drip into your bloodstream (intravenously).
With GvHD, monoclonal antibodies (mAbs) target and mark a specific protein. Then the immune system picks out the marked cells and kills them. This suppresses your immune system so treating the GvHD.
There are several types of monoclonal antibodies used for the treatment of GvHD. Examples of these include:
- infliximab
- rituximab
mTOR inhibitors (sirolimus or everolimus)
Sirolimus and everolimus are a type of targeted drug therapy called an mTOR inhibitor.
mTOR is a type of protein called a kinase protein. It can make cells produce chemicals to trigger cell growth. So mTOR inhibitors stop cells from growing and dividing. This helps dampen down the immune system.
Sirolimus
Sirolimus is also known as Rapamune. We know from research that sirolimus can help to prevent GvHD. You might have it to treat acute or chronic GvHD.
You take sirolimus as tablets or a solution that you drink.
Sirolimus solution contains soya oil. Patients allergic to peanut or soya must not take this medicine.
Some of the common side effects for sirolimus include:
- low levels of platelets or red blood cells
- a high temperature
- high blood pressure
- low levels of some important chemicals in the blood (potassium and phosphate)
- pain in the abdomen
- diarrhoea or constipation
Everolimus
You might have everolimus instead of sirolimus. You take everolimus as a tablet.
What else do you need to know?
You should not have grapefruit or grapefruit juice when taking sirolimus or everolimus. This is because it can interfere with how these medicines works.
You have regular blood tests to check your liver and kidney function.
You may have sirolimus and everolimus with other drugs that suppress your immune system.
Tyrosine kinase inhibitors (TKIs)
Tyrosine kinase inhibitors (TKIs) are a type of targeted drug therapy.
They block messengers (enzymes) which send growth signals inside cells. So they stop the cells from growing and dividing.
Imatinib (Glivec) is a example of a type of TKI you may have for acute and chronic GvHD, particularly if it's affecting the skin or lung. You take this as a tablet.
You might have another type of TKI called ibrutinib. You take ibrutinib as a tablet.
Etanercept
Etanercept blocks a chemical called tumour necrosis factor (TNF) from causing damage to tissue. You have it as an injection under your skin.
You are most likely to have it for acute GvHD. Etanercept may be particularly helpful for GvHD affecting the gut.
Side effects may include:
- increased risk of infection
- headaches
- reaction at and around the injection site such as pain, itching swelling, bleeding, redness and bruising
Ruxolitinib
Ruxolitinib works by blocking proteins called Janus Associated Kinases (JAKs). This helps stop an immune response and lessens the symptoms of GvHD.
You might have ruxolitinib for acute or chronic GvHD.
Light treatment (ECP)
This is also known as extracorporeal photopheresis, photopheresis or light therapy. ECP can improve chronic GvHD of the skin, liver, mouth and lung.
You normally have ECP after other treatment hasn’t worked or has stopped working. ECP may take between 6 and 12 months before you see any real improvement in symptoms.
Your doctor refers you to a skin specialist (dermatologist) if they think ECP may help your GvHD. You might need to go to a different centre that offers this treatment.
Before your treatment
Drink plenty of fluids such as water and juice.
Avoid eating foods that are high in fat preferably from the night before treatment. Or at least 6 hours before treatment. This is because it can affect how well the treatment works.
Ask your treatment team for examples of high fat foods.
How you have it
You usually need to have a for this treatment.
Your nurse connects you to a machine by a drip. Your blood goes through the machine, which separates off some of your . Then the nurse gives you back your blood into your vein, minus the white blood cells.
The separated white blood cells are treated with a special drug and then exposed to ultraviolet light. This light activates the drug so that it is able to destroy the abnormal white blood cells. After this process your nurse gives back the treated white blood cells into your vein.
Each treatment takes between 1 and a half hours to 3 hours. You usually have it every 2 weeks. You usually have ECP for between 6 and 12 months.
Side effects
Having this procedure does not hurt.
You might feel a bit weak, lightheaded or dizzy during or after the treatment. It can also make you feel sick. These symptoms usually stop when the procedure is finished.
Around 6 to 8 hours after your treatment you might have:
- depending on the colour of your skin it may go red, darken or lighten
- skin that is more itchy
- a high temperature
Your nurse will usually advise you to take paracetamol to help the high temperature. You may need an to help the itching. Skin moisturisers can also help.
After the treatment your skin and eyes may be more sensitive to sunlight for about 24 hours. So you need to protect yourself from the sun by:
- covering up
- staying in the shade
- wearing sunscreen
- wearing sunglasses
Thalidomide
Thalidomide dampens the immune system.
Some research has shown that it can help to control chronic GvHD. Doctors don't use it very often and usually only if other treatments are not controlling the GvHD. You take thalidomide as a tablet.
It is essential to avoid pregnancy while taking thalidomide and for a number of weeks afterwards
Belumosudil
This medicine suppresses the immune system. It works by blocking the signals that create an immune response.
You take it as a tablet.
You might have it for chronic GvHD if you have 2 or more previous treatments that haven’t worked.
Some of the common side effects of belumosudil include feeling sick and extreme tiredness.
