Cancer Research UK on Google+ Cancer Research UK on Facebook Cancer Research UK on Twitter

Treatment for acute GVHD

Landing page coping image

This page tells you about the treatment of acute graft versus host disease (GVHD). You will have treatment to manage your symptoms as well as treatment for the GVHD itself. There is information below about

 

The grades of GVHD

Your treatment will depend on the grade of your GVHD. The grade depends on the number of organs affected (skin, bowel, or liver). GVHD can affect any or all of these 3 organs. The grade also depends on how bad it is.

Grade 1 is mild GVHD  – a quarter (25%) of your skin is affected.

Grade 2 is moderate – up to half your skin (25 to 50%) is affected. There are mild changes in your liver or you may have some mild diarrhoea or nausea.

Grade 3 is severe – more than half your skin (50% +) is affected. You may look as though you have severe sunburn. Your liver is affected and you have stomach cramps and diarrhoea.

Grade 4 is very severe – your skin has blistered and may have broken down in places. Your skin may be yellow (jaundiced) because your liver is not working properly. You have severe diarrhoea.

If you have grade 1 GVHD you may not need any treatment. But you will need some type of treatment for grade 2 or above.

 

General treatments

Treatment is based on drugs that reduce your body’s immune response and reduce the number of T cells. The most common treatment is corticosteroids (usually prednisolone). The side effects they can cause are described on our page about steroids in the cancer drug section.

Sometimes a drug called ciclosporin is used with the steroids. Ciclosporin is also called Deximune, Neoral or Sandimmum. You take it as a tablet. 

Sometimes steroids and ciclosporin do not control GVHD. Newer treatments being used in that situation include infliximab (Remicade), daclizimab (Zenapax) and rituximab (Mabthera).

You can find information about these drugs and their side effects on our page about the drugs used to treat GVHD.

 

Treating acute skin GVHD

The most common treatment for skin GVHD is steroids. Your treatment will depend on the grade of GVHD you have. Mild GVHD may get better without any treatment, other than keeping your skin well moisturised. Or you might have treatment with a steroid cream to the affected areas.

If you have moderate skin GVHD you will probably have either a steroid cream or a course of steroid tablets. If you have stage 3 to 4 skin GVHD you will need to take steroids through a drip (intravenously). You might also need other drugs for GVHD to reduce your immune reaction.

Your doctor may refer you to a skin consultant (dermatologist) for specialist advice on how to treat and manage your skin. They may prescribe special moisturising creams and bath oils.

What you can do to help yourself

There are some things you can do to help keep your skin more comfortable

  • Wear cotton clothes
  • Try not to get too hot or too cold
  • Use unperfumed soaps
  • Use warm, not hot, water for washing
  • Let your skin dry in the air, or gently pat it dry – don’t rub it
  • Keep your skin well moisturised
 

Treating acute gut GVHD

GVHD of the gut may give you sickness or diarrhoea. This can make you dehydrated. To prevent and treat dehydration, you will have fluids by drip into a vein. Your doctor or nurse will also give you painkillers if you have any abdominal or stomach cramps, and anti sickness drugs for nausea.

If you are unable to eat for some time, and are losing weight, you may need feeding through a tube. This may be either a tube into your stomach, or directly into your bloodstream through a central line, PICC line or portacath.

Treatment of the GVHD itself is based on drugs that reduce your body’s immune response and lower the number of T cells. The main treatment is steroids which generally work well. Your doctor might also treat you with other drugs to suppress your immune system and so reduce the GVHD.

If you have a sore mouth your doctor may recommend the drugs clofazimine or thalidomide. Light therapy with extracorporeal photophoresis can also help.

What you can do to help yourself

There are some things you can do to help with sickness and diarrhoea

  • Drink plenty of fluids – tell your doctor or nurse if you feel sick and find it difficult to drink
  • Take anti sickness drugs to reduce your nausea
  • Take the painkillers your nurse gives you
  • If you have diarrhoea, keep the area around your back passage clean and dry – you may need a barrier cream to try to prevent the skin getting sore and breaking down
 

Treating acute liver GVHD

You may not have symptoms of liver GVHD. Your doctors may have picked it up from your regular liver function tests (LFT). GVHD of the liver is graded according to the amount of bilirubin in your blood. Bilirubin is a waste product made when red blood cells break down. A raised bilirubin level in the blood can show that the liver isn’t working properly. The more bilirubin you have, the higher your grade of GVHD will be.

Doctors treat liver GVHD with steroids. They may also give you other drugs to reduce the number of T cells your new bone marrow is making.

If you have symptoms of liver GVHD you might have

  • Drugs to relieve itchy, jaundiced skin
  • Blood transfusions if you have a low red blood cell count (anaemia), or a low platelet count
  • Painkillers

Your doctor will continue to do regular liver function tests to check how the treatment is working. If you are taking any drugs that are known to affect the liver you may need to stop taking them or cut them down (with your doctor’s say so, of course). Your doctor may also refer you to a consultant specialising in gut and liver problems (a gastroenterologist).

What you can do to help yourself

There are things you can do to help with liver GVHD symptoms

  • Don’t get too cold or too hot – this can make itching worse
  • Wear cotton instead of man made fabrics like nylon
  • Take the drugs your doctor or nurse gives you to help with any itching
  • Take painkillers regularly – they will work better than if you take them now and again
 

Where to find more information

There is detailed information in the section about the drugs used to treat GVHD.

Rate this page:
Submit rating

 

Rated 5 out of 5 based on 3 votes
Rate this page
Rate this page for no comments box
Please enter feedback to continue submitting
Send feedback
Question about cancer? Contact our information nurse team

No Error

Updated: 17 April 2013