GVHD: The Good, the bad, and the ugly .

 

So what is Graft vs Host Disease (GVHD) anyway.  Here’s a quick tutorial.

GVHD occurs when the donor stem cells attack the hosts body.  Kristina’s body in this case.   In about 60-80% of non related donor transplants, the stem cells recognize portions of the the host’s (Kristina’s) body as ‘foreign’ and attack.  This ‘attack’, in a mild form, is actually good.  When the stem cells say ‘let’s attack any blast (leukemia) cells we see’, it’s a great thing.  Stem cells doing what stem cells do.  Facilitating fresh blood cells of different types (see prior post on how magical stem cells are) and attacking the bad guys.

But when they attack other organs of the body it can either be bad, but treatable, or in severe cases damn ugly.

GVHD may manifest itself in many ways and can be either acute or chronic.   Symptoms may be mild or severe.  It may come shortly after the transplant or take years to develop. The uncertainty of if, when, and how it may develop that has its own special form of cruelty, coming after the treatment of AML, a life threatening condition.  You get through all the rounds of Chemo, the transplant, all that stuff and, oh yeah, you might, or might not develop GVHD.  And  it might or might not be severe.  And the symptoms are so wide spread, that initially they might be GVHD or a mild reaction to spicy food. 

Consider Kristina’s arc of this last round of AML.  It started in May, confirmed in early April, and her first thoughts were “it’s back, I need to get my affairs in order”.  Then hope was dangled.  To her initial astonishment, she was deemed to be viable for a transplant.  She hadn’t thought that possible.  Then the rounds of Chemo, delay, all the emotional and physical hardship associated with chemo and transplant.

And now GVHD – with its wildly uncertain trajectory.  But, as we said, a little bit is actually good.  Kind of like bitters in a cocktail.  A little bit is good.  But not too much.

Let’s break down GVHD.  The symptoms for the acute form include abdominal pain, nausea, vomiting and diarrhea.  Liver problems, like jaundice can occur.  Rashes, itching or redness on the skin.  And increased risk for infections.

Pause for a moment and consider that post transplant patients are already at increased risk for infection.  Which has its own socially isolating aspect to it.  We humans are and live it a pathogen infested environment.  We transmit all sorts of stuff between us and for most of us it’s benign.  Our immune systems do the battle quietly and we aren’t aware of most of the things they deal with.

What for us may be an infection that was negated before we even knew about it could be a life-threatening thing to someone who is immunocompromised.

The chronic form is more sinister and may result in vision changes, dry mouth, sensitivity to spicy foods, fatigue, chronic pain, skin rashes, lung damage, liver damage with reduced bile flow, damage to sweat glands, and inflammation to the membrane surrounding the heart causing chest pain.

The treatments include prednisone, a steroid, that can alter moods, disrupt sleeping, weight gain, other stomach problems, etc.

As GVHD can damage the liver, lungs, digestive track and other organs, it’s a serious thing.  Treatments can be successful or GVHD may result in a life changing chronic thing.

So in a nutshell, that’s GVHD.  In its most mild form it’s a good thing.  There are variants of mild, like a rash, that is treatable and really isn’t much of a thing.  It may be more severe and begome  a life changing chronic condition, or it may be truly ugly.  Patients have died from GVHD.   Given the choices, we’ll opt for the mild, good version.