Always follow the advice of your care team.
Graft-versus-Host Disease
One of the most common complications after an allogeneic transplant is graft-versus-host disease (GVHD). GVHD happens when your your donor’s stem cells see your body’s cells something foreign and attack them. It may occur early (acute) or late (chronic) after the transplant.
The symptoms of GVHD may be mild or severe.
Signs and Symptoms of Acute GVHD
Signs and Symptoms of Chronic GVHD
Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD can be long and recovery can be slow.
Chronic GVHD of the Mouth
Chronic GVHD (cGVHD) may develop in your mouth. It usually takes the form of soreness of the mouth (especially with eating, drinking, or tooth-brushing) accompanied by white lines, ulcers, and dry mouth. The lips are frequently affected and may at first seem like chapped lips. It is important to take good care of your mouth (teeth, gums, tongue) to help reduce infection, and sometimes symptoms related to chronic GVHD of the mouth. If you develop cGVHD, an oral medicine specialist is available to see you to help manage and treat it.
Here are some suggestions for oral care and comfort if you develop oral cGVHD.
Patients with cGVHD are at an increased risk for developing oral cancer and should be checked for this at least once a year. Oral cGVHD can look similar to early oral cancer lesions, so it is best to be seen by a specialist who is familiar with oral cGVHD, such as one of our oral medicine specialists. Periodic biopsies of suspicious lesions may be necessary.
For more about cGVHD, talk with your care team or visit www.brighamandwomens.org/surgey/oral-medicine-and-dentistry.
- Acute GVHD usually occurs within the first 100 days after your transplant. It can affect the skin, gastrointestinal tract, and liver.
- Chronic GVHD (cGVHD) may occur later. It affects the same systems as acute GVHD, but may also affect the eyes, mouth, lungs, joints, and vagina.
The symptoms of GVHD may be mild or severe.
Signs and Symptoms of Acute GVHD
- Skin: The skin is the most common site of acute GVHD. Skin GVHD usually starts as a rash. It can be pink, red, or purple in color and can be flat, raised, or both. The rash may be itchy or painful or you may not feel it at all and, in some areas, may start peeling. If you notice any changes in your skin, tell your care team so they can closely monitor these changes.
- Gastrointestinal tract: The GI tract is the second most common site of acute GVHD. Symptoms of GI GVHD include:
- Diarrhea (can be extreme) – 1-2 Liters per day
- Often watery, green, mucous-like, and can contain undigested food
- Blood in your stool
- Crampy abdominal pain
- Poor appetite
- Nausea or vomiting
- Indigestion or bloating
- Liver: Liver GVHD can present without visible symptoms. Jaundice, a yellowing of the skin or eyes, may occur, but infrequently. Most often, it is first identified with a blood test. A Liver Function Test (LFTs) are drawn every visit to monitor how your liver is working. If there is an abnormal or rapid increase in these numbers, it could be a sign of Liver GVHD. If you notice any yellowing of your skin or eyes or have pain on the right side of your abdomen, tell your care team.
Signs and Symptoms of Chronic GVHD
- Skin: Chronic GHVD of the skin can look like acute GVHD. Skin can also become swollen, irritated and/or tight. Your skin may become dry or bumpy. The pigment in your skin can change and either lose color or become darker in color.
- Nails: Your nails may become dry and brittle and can possible split or fall off.
- Scalp and hair: Chronic GVHD can cause your hair to thin, fall out in patches, turn gray, or become very coarse. Your scalp can have lesions or scaling.
- Eyes: Chronic GVHD can present as extremely dry eyes, pain, sensitivity to light, feeling like there is sand in your eye, eye infections, or swelling of the eyelids.
- Genitalia: Vaginal dryness is the most common feature for women leading to painful intercourse. Erectile dysfunction is the most comment feature for men. Speak with your care team for more information on prevention and treatment strategies.
- GI tract: Chronic GVHD can have similar symptoms as acute GVHD (Nausea, vomiting, poor appetite, diarrhea, weight loss, and poor nutrient absorption). Another symptom can be food feeling like it is stuck in your throat or chest after swallowing.
- Liver: Chronic GVHD in the liver can present as an increase in Liver Function Tests (LFTs). These tests are run on a sample of your blood.
- Lung: Notify your doctor or nurse if you have in hard time catching your breath or you feel short of breath more often. There are many other reasons you could be short of breath, but it is important that you tell your care team so they can follow your care and any changes closely.
- Muscles and joints: Signs of possible chronic GVHD of the muscle and joints includes swelling, joint stiffness, muscle weakness, muscle cramps, arthritis, and muscle tightness.
Management and treatment of these symptoms is controlled with medication. The treatment process for GVHD can be long and recovery can be slow.
Chronic GVHD of the Mouth
Chronic GVHD (cGVHD) may develop in your mouth. It usually takes the form of soreness of the mouth (especially with eating, drinking, or tooth-brushing) accompanied by white lines, ulcers, and dry mouth. The lips are frequently affected and may at first seem like chapped lips. It is important to take good care of your mouth (teeth, gums, tongue) to help reduce infection, and sometimes symptoms related to chronic GVHD of the mouth. If you develop cGVHD, an oral medicine specialist is available to see you to help manage and treat it.
Here are some suggestions for oral care and comfort if you develop oral cGVHD.
- If toothpaste makes your mouth hurt, switch to any children’s toothpaste or Biotene toothpaste. If you are unable to brush your teeth because of the soreness, rinse your mouth after meals with water or water mixed with salt and baking soda (1 cup water with 1/4 teaspoon baking soda, and 1/8 teaspoon salt). You can also use sponge-tipped Toothettes to clean food off your teeth until you can brush again.
- If you find that foods and drinks make your mouth feel sensitive and uncomfortable, avoid acidic foods, such as citrus fruits and tomato sauce. Also avoid salty, spicy, and crunchy foods. Eat a bland diet of soft foods and drink fluids frequently, avoiding carbonated or acidic drinks. Cold, slushy foods, such as popsicles and yogurt, may help reduce oral discomfort. Large- diameter, disposable straws also help to direct fluids away from sore areas of the mouth. If you have significant trouble eating, please tell your nurse. He or she may refer you to a nutritionist to help.
- Some of the following topical medications may help to temporarily reduce discomfort when applied to affected sore areas. Medications include: viscous lidocaine and magic mouthwash (prescription needed) and over-the-counter Orajel or Anbesol.
- Most patients with symptomatic oral cGVHD will require treatment with topical immunosuppressive therapies, including topical steroids and topical tacrolimus. You can get these prescriptions from your oncologist or oral medicine specialist.
Patients with cGVHD are at an increased risk for developing oral cancer and should be checked for this at least once a year. Oral cGVHD can look similar to early oral cancer lesions, so it is best to be seen by a specialist who is familiar with oral cGVHD, such as one of our oral medicine specialists. Periodic biopsies of suspicious lesions may be necessary.
For more about cGVHD, talk with your care team or visit www.brighamandwomens.org/surgey/oral-medicine-and-dentistry.