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.
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