Chronic Graft Versus Host Disease

What is cGVHD?

Chronic graft-versus-host disease (cGVHD) is a common and potentially life-threatening complication which develops as a result of allogeneic hematopoietic cell transplantation (HCT), when the transplanted cells react against the body of the recipient. The prevalence of this disease, unfortunately, varies from between 25–80% in long-term survivors. cGVHD can lead to serious physical and functional impairment that affects the quality of life as it is often diagnosed late in its course when the disability has already begun.

What are the Signs and Symptoms of GVHD?

Acute GVHD: In the early weeks and months after your transplant (usually within the first four months) you might notice a rash, or an upset stomach with nausea, vomiting or diarrhoea, or it could affect your liver tests, sometimes causing jaundice (yellow discolouration to the skin).   

Chronic GVHD: Can happen a few months after transplant and can reoccur for several years after transplant. Like acute GVHD, it may affect your skin, gut, liver or mouth. But it can also affect other parts of your body, such as your eyes, lungs, vagina and joints. Chronic GVHD may be mild or severe, and for some people can go on for several months or even years.

What are the clinical manifestations for cGVHD? cGVHD can effect basically any organs, with the most commonly affected sites being: the skin, the mouth, the eyes, the gastrointestinal tract, the muscles and joints, the lungs, the liver, and genitalia. From a musculoskeletal point of view, the main concern for the Allied Health Professionals are: SKIN FASCIA PERIPHERAL NERVES MUSCLE BONE (Due to use of cortisone) Manifestations typically appear within the first year after HCT. The most commonly affected joints include fingers, wrists, elbows, shoulders, ankles, and hips, with the distal joints often affected first (anecdotal evidence). cGVHD is an independent risk factor for joint destruction and associated pain and dysfunction.

What is the potential impact of musculoskeletal cGVHD on the Quality of Life (QoL) of the patients? The number of long-term survivors after allogeneic HCT has been increasing over the past years, and quality of life (QOL) has become an important end-point. The QoL in these patient group can be affected due to:

Decreased range of motion, significantly restricting a patient’s ability to perform activities of daily living. Painful joint contractures in some patients resulting in impaired function. Chronic graft versus host disease is an independent risk factor for joint destruction and associated pain and dysfunction. Some patients also show deteriorated role functioning and global QOL, increased fatigue, and skin problems. The long-term sexual complications include decreased libido, vaginal alterations, erectile and ejaculatory dysfunctions. Due to physical dysfunction, many patients also struggle to return to work post cGVHD.

How is GVHD diagnosed? ‘’Some GVHD may be a good thing because it means that your new immune system is working and is likely to be attacking any remaining disease cells. This can help stop the disease from coming back. You might hear this called graft versus tumour effect’’.

The early symptoms of GVHD are often the same as some side effects and complications after a transplant, so diagnosing GVHD can be hard. Although not definite some early signs might be clawing of the fingers in hand, reduce in ankle movement, skin changes and pain in the joints. Diagnosis is often made from your symptoms, as well as from the results of laboratory tests and tissue samples.