ACUTE GVHD -
The primary complication following a Bone Marrow Transplant for aplastic anaemia is Graft-Versus-Host disease (GVHD). In GVHD, the donor's bone marrow attacks the patient's organs and tissues, impairing their ability to function, and increasing the risk of infection. Depending on its severity, GVHD can be a temporary inconvenience or a life-threatening condition.

GVHD is often discussed as if it were a single disease. In fact, it is two closely related diseases: acute GVHD and chronic GVHD. Patients may develop one, both or neither. Acute GVHD occurs within the first 100 days after transplant, but most often between 15 and 40 days after stem cell infusion. Chronic GVHD occurs beyond day 100 after transplant. Acute GVHD can lead to chronic GVHD, but chronic GVHD may occur without any evidence of previous acute GVHD. The chronic version may occur up to several years after transplant. In patients receiving a graft from an HLA - identical brother or sister, ultimately the donor stem cells will function quite normally. Patients who receive grafts from HLA- mismatched donors will remain at an increased risk of infections for many years.

With acute GVHD the major targets are the skin, bowel, and liver. The skin is often the first tissue that shows signs of attack. A skin rash develops, often starting on the palms, soles, and behind the ears. It may spread to other parts of the body, developing into a general redness similar to a sunburn, with peeling or blistering skin. Cramping, nausea and watery or bloody diarrhoea are signs of acute GVHD in the stomach or intestines. Jaundice (yellowing of the skin and eyes) indicates GVHD has affected the liver.

Patients with chronic GVHD usually experience skin problems such as a dry, itching rash, a change in skin colour, and tautness or tightening of the skin. Occasionally, patients with chronic GVHD experience contractures (a tightening of the tendons in joints that makes extending or contracting arms and legs difficult). Partial loss or premature greying may also occur.

Chronic GVHD can also attack glands in the body that secrete mucus, saliva or other lubricants. Patients may experience dry or stinging eyes, a dry mouth and throat, and a burning sensation in the mouth when using toothpaste or eating acidic foods. The digestive tract may be affected by chronic GVHD, causing heartburn, stomach pain or weight loss. Chronic GVHD may also affect the liver and lungs, causing wheezing, bronchitis or pneumonia.

To reduce the incidence and severity of acute GVHD, patients are given immunosuppressive drugs . These drugs are routinely administered for approximately six months post- BMT , and longer if the patient develops chronic GVHD.

The risk of developing acute GVHD depends on the source of Bone marrow and the choice of medications given to prevent it. In most cases, patients develop only a mild or moderate form of the disease.

Although most patients recover from GVHD, symptoms such as skin sensitivity, eye irritation, chronic diarrhoea and, less frequently, lung and liver problems or contractures, may persist long-term. Most patients, however, do not experience long-term debilitating side effects.

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