Graft-versus-host disease
When the transplant attacks the donor’s cells
Two types of immune response are possible in the case of an allogeneic transplant: rejection and the graft-versus-host (GVH) reaction.
Graft-versus-host disease occurs when certain kinds of white blood cells, the lymphocytes, contained within the transplant attack the recipient’s tissues, which the former perceive as being foreign. In a phenomenon that is the inverse of rejection, the recipient’s body, which is in a state of immune deficiency, cannot respond to such an attack.
Acute graft-versus-host disease is seen in around 30% to 50% of allogeneic transplants among immediate family members and in 50% to 80% of such transplants not involving siblings.
Acute GVH disease
This disease usually occurs with the first 100 days following the transplant. Symptoms include:
- skin disorders: redness, itching, scaling
- liver damage: jaundice, elevated liver enzymes
- problems of the digestive tract: nausea, loss of appetite, vomiting, cramps and diarrhea
Chronic GVH disease
It generally occurs after the 100-day period following the transplant. Its onset is indicated to varying degrees by a wide spectrum of symptoms that can differ from one patient to another:
- skin disorders: sclerosis (thickening of the skin), hyperpigmentation, hair loss, nail dystrophy
- damage to the mucous membrane: ulcers, dryness
- digestive tract disorders: dysphagia (difficulty swallowing), malabsorption, pancreatic deficiency, diarrhea
- bone marrow disorders: anemia, leukopenia, thrombopenia
- liver damage
- musculoskeletal problems: pain, cramps, stiffness