You've probably heard of stem cell transplants. They are a very important treatment for some diseases. However, today we are going to talk about a complication that can occur after such a transplant. This is called `(Graft vs. Host Disease)` or `(GvHD)` for short. Don't worry, let's talk about this simply.
What is `(Graft vs. Host Disease - GvHD)`? Simply explained...
Imagine that you have received a stem cell transplant from someone else, a donor . We call this an allogeneic transplant. These stem cells are like immature cells in your body's blood-making factory, or hematopoietic stem cells. These are the cells that will later become the red blood cells and white blood cells that your body needs.
Now, when would you need stem cells from a donor like this? If you have a cancer like leukemia or lymphoma, or another disease where your bone marrow doesn't work properly like aplastic anemia, you may need this type of transplant.
Okay, now what is this `(GvHD)`? In `(GvHD)`, what happens is that the donor cells that you received (graft) see the cells in your body (host) as something strange, unfamiliar. It's like your body is a new place for them. So, these donor cells start attacking your body's cells. That's why it's called `(Graft vs. Host Disease)`, which means "graft against host." Do you understand?
What are the main types of GvHD?
There are two main types of GvHD. In the past, doctors classified it based on the time it took for symptoms to start. But now, they look at symptoms and test results to determine the exact type.
1. Acute GvHD (aGvHD)
This usually happens shortly after your stem cell transplant, often within the first 100 days . However, sometimes symptoms can start later. Acute GvHD most often affects your skin, digestive system (GI tract), or liver.
2. Chronic GvHD (cGvHD)
Chronic GvHD can occur at any time after an allogeneic transplant. However, it most often begins within two years . Chronic GvHD can affect your skin, mouth, liver, lungs, GI tract, muscles, joints, or genitals.
Important: You may develop one, both, or neither of these types of GvHD. It varies from person to person.
What are the symptoms of `(GvHD)`? Be aware of these!
The symptoms of GvHD vary from person to person. Some people may have mild symptoms , some may have moderate symptoms , and others may have severe (even life-threatening) symptoms.
Symptoms of acute `(GvHD)`
We have already said that acute GvHD most commonly affects the skin, the GI tract, and the liver.
- Skin (aGvHD): The most common symptom is a skin rash or redness (like a sunburn). There may be pain and itching. The rash usually starts on the neck, shoulders, ears, palms, and soles of the feet. It can then spread to other parts of the body.
- Gastrointestinal (GI) tract (aGvHD): The most common symptoms are nausea, vomiting, and diarrhea (bloating). These symptoms can be mild or severe enough to require hospitalization.
Common symptoms of acute GvHD include:
- A skin rash and/or itching.
- Diarrhea.
- Nausea and vomiting.
- Stomach ache, limping.
- Jaundice (yellowing of the skin and/or eyes).
Symptoms of chronic GvHD
Chronic GvHD most commonly affects your skin, liver, GI tract, and lungs. However, it can affect any part of your body.
Symptoms may include:
- A skin rash and/or itching.
- Skin tightening and swelling.
- Hair loss on the head and body.
- Dry mouth.
- Mouth sores.
- Gum disease.
- Dry eyes, feeling like a grain of sand is stuck inside.
- Changes in vision.
- Diarrhea.
- Nausea and vomiting.
- Yellowing of the skin and/or eyes (jaundice).
- Difficulty breathing (dyspnea).
- Dry, persistent cough.
- Fatigue.
- Muscle weakness, limping, or pain.
- Inability to bend and extend joints properly.
- Women may experience vaginal dryness, itching, or pain during intercourse.
- Men may experience itching of the penis or testicles, or pain during intercourse.
Why does this `(GvHD)` occur? What is the cause?
Simply put, GvHD occurs when the stem cells from the donor you received the transplant see your own body cells as "foreign" and start attacking them.
This is what usually happens: Your immune system cells (cells in your blood) protect you from disease. They fight off foreign substances, such as viruses and bacteria. However, these cells do not attack your own cells. This is because your cells have a special protein called ``Human Leukocyte Antigens'', or ``HLA''. This is like a tag with a name on it. This ``HLA'' is what tells your immune cells, "Hey, this is one of ours."
The most important thing is that, except for identical twins, everyone's `(HLA)` is different from each other.
After you receive a stem cell transplant from someone else, the new blood cells in your body don't have your `(HLA)`, but the `(HLA)` of the donor . So, if the `(HLA)` of this donor is very different from the `(HLA)` in your body, those new blood cells start to attack your body's cells. That's when `(GvHD)` occurs.
This is why doctors carefully check the donor's HLA to make sure it is as close to yours as possible before performing a stem cell transplant. Finding a match like that reduces the risk of developing GvHD. However, if you don't receive cells from an identical twin, there is still a chance that you will develop GvHD, no matter how many matches you try.
Who is most at risk of developing GvHD?
The most important risk factor is how closely your donor's HLA matches yours. You are at higher risk of developing GvHD if:
- You received stem cells from a relative, but not an exact HLA match .
- You received stem cells from someone who is not your relative, but is an `(HLA)` match .
Other risk factors are:
- The donor must be a woman who has been pregnant before.
- Increasing age of the donor or yourself.
- Gender incompatibility between the donor and you (e.g. receiving cells from a male donor to a female, or from a female donor to a male).
- If the donor's stem cells are taken from the blood vessels (blood) instead of from the bone marrow (where blood cells are produced).
If you have already had acute `(aGvHD)`, you are at increased risk of developing chronic `(cGvHD)`.
How is GvHD diagnosed?
Your doctor can diagnose GvHD by examining you, looking at your symptoms, and looking at lab tests and biopsy results. A biopsy involves taking a small sample of your tissue or cells and sending it to a lab for testing.
In chronic GvHD (cGvHD), some of the symptoms can be similar to other diseases. Therefore, the doctor will rule out all other causes before making a definitive diagnosis of cGvHD.
What are the treatments for GvHD?
After you receive a stem cell transplant, you will be given immunosuppressive medicines as a prophylactic measure to reduce the ability of the donor cells to attack your own tissues.
If these medications do not stop the development of GvHD, your doctor will prescribe treatment based on the severity of your condition and the type of GvHD.
Treatment of acute GvHD
Doctors often successfully treat people with acute GvHD by increasing the dose of drugs that suppress the immune system. These belong to a class of drugs called corticosteroids. They can be given by mouth, intravenously, or topically. If steroids don't work, your doctor may prescribe a drug like Ruxolitinib (Jakafi®). You may also have the opportunity to take part in clinical trials that test new treatments.
Treatment of chronic GvHD
Chronic GvHD is usually treated with long-term immunosuppressive medications. If these medications don't help, your doctor may prescribe medications like:
- `Ruxolitinib (Jakafi®)`
- `Belumosudil (Rezurock™)`
- `Ibrutinib (Imbruvica®)`
- Photopheresis (This is a special treatment method)
You may also be eligible for ``clinical trials.'' The doctor will tell you about that.
What are the complications/side effects of the treatment?
Because these immunosuppressive medicines weaken your immune system, you are more likely to develop fungal, bacterial, and viral infections . Therefore, your doctor will prescribe several other medications to protect you from these dangerous infections.
Can GvHD be prevented?
Tissue typing labs are constantly developing and using new, more accurate DNA-based tests. This allows your medical team to select the donor with the most HLA match for you. The better the match, the better the chance of preventing GvHD.
Also, your doctor will prescribe immunosuppressants to prevent GvHD after your stem cell transplant.
Can GvHD be completely cured?
In most cases, doctors can successfully manage the condition (GvHD). That is, they can control the symptoms and help you live a normal life.
Meanwhile, researchers are studying new ways to prevent GvHD through clinical trials. For example, they are investigating various immunosuppressive drugs and new prophylaxis medications.
Can GvHD be life-threatening?
Yes, GvHD can sometimes be life-threatening. Chronic GvHD is the leading cause of death among people who receive an allogeneic stem cell transplant, aside from their primary disease.
Therefore, before undergoing any treatment – even a stem cell transplant – it is very important to discuss the risks with your doctor. He or she can explain the risks to you and help you weigh the pros and cons of the treatment.
Is there sometimes an advantage to `(GvHD)`?
Don't be surprised, although GvHD can have a negative impact on your quality of life, it also has some benefits. The same immune response that attacks your normal cells also seeks out and destroys any cancer cells that may be left in your body. This is called the graft-versus-tumor effect. People who develop GvHD have been found to be less likely to have their primary disease (especially cancer) return.
How do I take care of myself? Follow these tips!
Your doctor will explain to you how you should take care of yourself after your stem cell transplant. For example, what symptoms to watch out for and what symptoms to call your medical team immediately if you develop. If you are at risk for developing GvHD, they may also give you additional care instructions. These instructions include:
- Protect your skin from the sun. Wear long-sleeved shirts and long pants. Use a sunscreen with at least SPF 50. (Sun exposure can worsen or trigger GvHD.)
- Maintain good oral health. This will reduce the risk of developing gum disease.
- Avoid spicy foods that can upset your stomach and cause mouth ulcers.
- Take steps to protect yourself from germs. (Your doctor will tell you more about this.)
When should I see the doctor?
It is important to notify your doctor immediately if you have any physical changes, especially signs of infection and a fever (100.4 Fahrenheit / 38 Celsius or higher). When you take immunosuppressants, you are at increased risk of developing infections that can be life-threatening.
After an allogeneic stem cell transplant, your doctor will monitor you closely for complications such as Graft vs. Host Disease (GvHD). If you develop symptoms of acute or chronic GvHD, your doctor may change your medication or prescribe a new medication. Take all medications exactly as prescribed. Follow your doctor's instructions about how to care for yourself, especially about how to protect yourself from infections.
The most important things to remember in short!
Okay, so Graft vs. Host Disease, or GvHD, is a complication that can occur after receiving a stem cell transplant from someone else. Simply put, it's when the donor cells attack your own cells.
Remember, there are treatments for GvHD, and the condition can be managed. The most important thing is to follow your medical team's instructions carefully and to let them know about any new symptoms as soon as possible.
If you have any further questions about this, don't be afraid to ask your doctor. They are the ones who can best help you.
` GvHD, stem cell transplant, allogeneic transplant, immune system, HLA, donor cells, symptoms
💬 අදහස් (0)
තවමත් කිසිදු අදහසක් පළ කර නොමැත. ඔබේ අදහස පළමු වරට මෙහි එක් කරන්න.
ඔබේ අදහස එක් කරන්න