Treatment for acute GvHD

Graft versus host disease (GvHD) is a possible complication after a bone marrow or stem cell transplant from another person. Generally, chronic GvHD starts more than 100 days after your transplant. Treatment is different for acute GvHD.

Treatment for chronic GvHD

Grading acute GvHD

Your doctor grades acute GvHD as mild, moderate, severe or very severe. Acute GvHD mainly affects the skin, ​digestive system​ or ​liver​. 

Your treatment depends on the grade of your GvHD. You might not need any treatment if you have grade 1, or mild, GvHD. But you will need some type of treatment for moderate to severe GvHD. This is grade 2 to grade 4.

Find out more about the grades of acute GvHD

What are the possible treatments for acute GvHD?

Treatment is based on drugs that lower your body’s ​immune response​ and lower the number of ​T cells​. The most common treatment is ​steroids​.

Doctors sometimes use a drug called ciclosporin with the steroids. You take ciclosporin as a capsule. Or you might have it through a drip into your bloodstream (intravenously).

Sometimes steroids and ciclosporin do not control GvHD. This is called steroid resistant GvHD. In this case, your doctor will use other treatments which may include:

• a type of light therapy called ​extracorporeal photopheresis (ECP)​

• ​monoclonal antibodies (mAbs)​ such as infliximab or rituximab

• ​chemotherapy​ such as methotrexate

• medicines to supress your immune system such as mycophenolate mofetil (MMF)

• medicines that reduce ​inflammation​ such as etanercept

• ​cancer growth blockers​ such as ruxolitinib or imatinib

Find out about the drugs used to treat GvHD

Treating acute skin GvHD

The most common treatment for skin GvHD is steroids. Your treatment depends on the grade of GvHD you have and on your individual situation.

This is a general guide to treatment based on the grade of acute GvHD.

Mild GvHD (grade 1)

This may get better without any treatment, but you will have to keep your skin well moisturised. Or you might have treatment which involves applying a steroid cream to the affected areas.

Moderate GvHD (grade 2)

You usually have either a steroid cream or a course of steroid tablets. Or you might have intravenous steroids.

Severe GvHD (grade 3 and 4)

You will need to have intravenous steroids.  

You might also need other medicines for GvHD to reduce your immune response.

Your doctor might refer you to a skin doctor called a dermatologist for specialist advice on how to treat and manage your skin. They may give you special creams, ointments and bath oils.

You might also have treatment to help relieve itching and pain.

Light therapy with ECP can also help.

What you can do to help yourself 

There are some things you can do to help keep your skin more comfortable. For example:

• 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 air dry or gently pat it dry – don’t rub it. You might find that air is painful if you have severe skin GvHD. So you may prefer to keep the area covered

• keep your skin well moisturised with unperfumed creams or lotions

• protect your skin from the sun by covering up, staying in the shade and using sunscreen

Treating acute GvHD of the digestive system

GvHD of the digestive system can cause:

• you to feel or be sick

• diarrhoea

• tummy cramps

• indigestion

• loss of appetite and weight loss

• pain

The main treatment is steroids, which generally works well. You might have other medicines to dampen down your immune system to help lessen the GvHD.

Light therapy with ECP can also help.

Treatment to help with symptoms

To control your symptoms, you might need:

• intravenous fluids to prevent and treat ​dehydration​

• painkillers if you have any tummy (abdominal) cramps or pain

• anti sickness medicines if you feel sick

• medicines to control your diarrhoea 

• special nutritional feeds through a tube into your stomach, or directly into your bloodstream, if you can't eat and are losing weight

Once you are able to eat, you start with a diet that is low in:

• ​fibre​

• fat

• lactose – a type of sugar found in milk and dairy products

You should also avoid spicy and acidic foods as they can irritate your gut. You may find that your taste has changed and things you thought were easy to tolerate don’t anymore.

Speak to your healthcare team if you have a problem with eating, digestion or weight loss. There are specialists who can help you. Your doctor will most likely refer you to the hospital dietitian for help.

Find out more about managing diet problems

What you can do to help yourself 

There are some things you can do to help yourself. These include:

• drinking plenty of fluids – tell your doctor or nurse if you feel sick and find it difficult to drink

• taking your anti sickness medicines regularly

• taking the painkillers that your team give you

• keeping the area around your back passage clean and dry if you have diarrhoea. You may need a barrier cream to try to prevent the skin getting sore and breaking down

Find out about drip or tube feeding

Treating acute liver GvHD

You might not have symptoms of liver GvHD. Your doctors might have picked it up from a blood test. Your doctors regularly check how well your liver is working during cancer treatment. The tests are called liver function tests or LFTs.

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 high 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. Knowing the grade of GvHD helps your team plan and monitor your treatment. You might need more treatment for a higher grade of GvHD.

You might develop symptoms if your liver GvHD gets worse. Symptoms may include jaundice. This means you might have yellowing of the whites of the eyes or skin. This may look different in people who have black or brown skin. Instead, it might be easier to notice yellowing of the inside of your tongue, gums or the tissue on the inside of your mouth. Your palms and soles of your feet may show a yellow tinge.

Other symptoms may include:

• feeling or being sick

• diarrhoea

• abdominal pain or cramps

• itchy skin

Doctors treat liver GvHD with steroids. You might also have medicines such as ciclosporin to lower the number of T cells that your new ​bone marrow​ is making.

You might also have light therapy with ECP to help.

Other supportive treatment

If you have symptoms of liver GvHD you might have:

• medicines to relieve itchy skin

• blood transfusions if you have a low number of red blood cells

• platelet transfusions if you have a low number of ​platelets​

• painkillers for tummy cramps and pain

• anti sickness medicines

• medicines to control your diarrhoea

• fluids intravenously to prevent and treat dehydration

You continue to have regular liver function tests to check how the treatment is working. You might need to cut down or stop taking medicines that are known to affect the liver. Your doctor will let you know what you should and shouldn’t be taking. 

Your transplant doctor might also refer you to a doctor specialising in liver and digestive system problems. This doctor is called 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 (synthetic) fabrics like nylon.

• Take any medicines that your doctor or nurse gives you to help with itching.

• Take painkillers regularly, as prescribed by your doctor – they work better than if you take them now and again.

Find out more about the medicines you might have for GvHD

The risk of infections

The treatment for acute GvHD will make you more at risk of picking up infections. So you will have antibiotics to try and reduce the risk. Infections can be serious, particularly if your immune system is very weak.

Talk to your doctor or specialist nurse about things you can do to try and avoid infection. In general, you should avoid crowded places and people with infections.