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Acute Graft versus Host Disease
WHAT YOU NEED TO KNOW:
What is graft versus host disease (GVHD)?
GVHD can happen after you have a bone marrow or stem cell transplant. In GVHD, cells transplanted from the donor (the graft) attack your body (the host). This most commonly causes damage to your skin, liver, or digestive system. Acute GVHD happens in the first 100 days after your transplant.
What increases my risk for GVHD?
- Older age of you or the donor
- A mismatch of tissues and cells between you and the donor
- A transplant with peripheral stem cells
- A transplant from a donor who is not related to you
- A transplant from a female donor who has had multiple pregnancies
- Cytomegalovirus infection of you or the donor
What are the signs and symptoms of acute GVHD?
Symptoms may be mild to severe. You may have any of the following:
- A skin rash, itching, or areas of red skin
- Yellow skin or whites of your eyes
- Abdominal pain or loss of appetite
- Diarrhea, nausea, or vomiting
How is GVHD diagnosed and treated?
Your healthcare provider will examine you. Tell him about your symptoms. You may need blood tests to check for infection, liver function, and get information about your overall health. Biopsies may be taken from your skin, liver, or intestine. A biopsy is a procedure to remove a sample of tissue. You will need medicines to stop the donor cells from attacking your body. Medicines may be given as a pill or an injection through an IV. You may also need antibiotics to prevent infection and medicines to manage your symptoms.
How do I care for my skin?
- Apply cream or lotion as directed. Use a moisturizing lotion without a scent or apply prescription cream as directed.
- Wear loose-fitting clothing. This will help prevent rubbing against your skin.
- Do not scratch your skin. This can increase your risk for infection.
- Protect your skin from sunlight. Sunlight can make symptoms of GVHD worse. Wear sunscreen that is at least SPF 30. Reapply sunscreen every 1 to 2 hours while you are outside. Also wear a hat, a long-sleeved shirt, and pants when you are in the sun. Try to stay in the shade as much as possible.
How do I manage diarrhea?
- Drink plenty of liquids. Liquids will help replace body fluids lost through diarrhea. You may also need to drink an oral rehydration solution (ORS). An ORS has the right amounts of sugar, salt, and minerals in water to replace body fluids. ORS can be found at most grocery stores or pharmacies. Ask how much liquid to drink each day and which liquids are best for you.
- Do not drink or eat foods that may make your symptoms worse. These include milk and dairy products, greasy and fatty foods, spicy foods, caffeine, and alcohol. Keep a food diary to see if your symptoms are caused by certain foods. Bring this to your follow-up visits.
- Eat foods that may help your symptoms. These include bananas, boiled potatoes, cooked carrots, cooked chicken, plain rice, and toast.
- Care for your rectal area. Clean this area with warm water and soap after you have a bowel movement. You can also use soft cleansing wipes. Ask your healthcare provider about medicated wipes that may decrease discomfort.
How do I prevent infection?
- Wash your hands often. Use soap and water or a germ-killing gel. Wash your hands after you use the bathroom, change a diaper, and sneeze. Wash your hands before you touch your face, and prepare or eat food.
- Keep your home clean. Wipe down bathroom and kitchen surfaces with cleaners that contain bleach. Clean floors and carpets regularly.
- Use safe food practices. Cook meat and vegetables thoroughly. Store extra food and leftovers in the refrigerator within 2 hours after preparation.
- Do not spend time with people who are sick. This includes people who have a cold, flu, infection, or rash. You should stay out of crowded places, such as malls and elevators.
- Be careful with pets and animals. Do not change your cat's litter box. Play gently with cats. Scratches from cats or other animals can get infected. Stay away from puppies, kittens, and young animals. They can spread disease and cause you to get an infection.
- Wear a mask as directed. You may need to wear a mask when you leave your house or when people visit.
- Talk to your healthcare provider about vaccines. Vaccines, such as the flu and pneumonia vaccine, can help prevent infections.
What do I need to know about nutrition?
A registered dietitian can help you find an eating plan that is right for you. You may need a special diet.
Call 911 for any of the following:
- You have trouble breathing.
When should I seek immediate care?
- Your heart is beating faster than usual.
- You feel weak, dizzy, or faint.
- Your abdominal pain suddenly gets worse.
- You urinate very little or stop urinating.
- Your skin begins to peel or fall off.
- You have blood in your urine or bowel movements.
- You vomit blood.
When should I contact my healthcare provider?
- You have a fever greater than 100.4 °F or chills.
- Your symptoms do not get better with treatment.
- Your skin is red, swollen, or draining pus.
- You have open areas on your skin.
- You cannot stop vomiting.
- You cannot take your medicine.
- You have eye pain or changes in your vision.
- You have sores, bumps, or a rash on your genitals.
- You have questions or concerns about your condition or care.
Care AgreementYou have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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