From the Guidelines
Graft-Versus-Host Disease (GVHD) manifests as an immune reaction where donor cells attack the recipient's tissues, occurring primarily after allogeneic hematopoietic stem cell transplantation, with manifestations including skin, gastrointestinal, and liver injury, as well as potential involvement of multiple organs in chronic GVHD, as noted in the most recent study 1.
Overview of GVHD
GVHD can be acute or chronic, with acute GVHD typically developing within 100 days post-transplant and affecting the skin, gastrointestinal tract, and liver.
- Skin manifestations include a maculopapular rash that may progress to blistering and desquamation, often starting on the palms, soles, and ears before becoming widespread.
- Gastrointestinal involvement presents as diarrhea, abdominal pain, nausea, and vomiting, while liver involvement causes elevated liver enzymes and jaundice.
Chronic GVHD
Chronic GVHD occurs beyond 100 days post-transplant and resembles autoimmune disorders, affecting multiple organs including:
- Skin (scleroderma-like changes, hyperpigmentation)
- Mouth (dryness, ulcers, lichen planus-like lesions)
- Eyes (dryness, conjunctivitis)
- Lungs (bronchiolitis obliterans)
- Musculoskeletal system (fasciitis, joint contractures) As noted in 1, chronic GVHD is the leading cause of non-relapse mortality after allogeneic hematopoietic cell transplantation and has a profound impact on quality of life.
Management and Treatment
The management of GVHD can be optimized by providing coordinated care from a multidisciplinary team, preferably in medical centers with access to specialized transplant services, as recommended in 1.
- Systemic corticosteroids are the mainstay of initial treatment and are commonly used in conjunction with a T-cell inhibitor (cyclosporine or tacrolimus) 1.
- In corticosteroid-refractory GVHD, numerous therapies have been studied, including cyclophosphamide, biologics, and photopheresis, with varied success depending on the tissues involved and the severity of the disease.
Ocular GVHD
For ocular GVHD, aggressive lubrication and punctal occlusion can be considered, with a role for topical corticosteroids in treating conjunctival hyperemia and scarring, as noted in 1.
- Topical T-cell modulator (cyclosporine) and autologous serum tears can be used to treat dry eye syndrome associated with GVHD.
- Treating the underlying inflammatory may help to reduce conjunctival damage leading to dry eye disease.
From the Research
Manifestations of Graft-Versus-Host Disease (GVHD)
The manifestations of GVHD can be acute or chronic and affect various organs and tissues. Some of the key manifestations include:
- Ocular involvement, which can range from mild to severe and may result in vision loss 2
- Dry eye disease, which is a common manifestation of GVHD 2
- Skin manifestations, which have been described in the literature, but the specific details are not provided in the given studies
- Systemic GVHD, which can be lethal and cause severe damage to different organs and tissues 2
- Involvement of the lacrimal gland, meibomian glands, cornea, and conjunctiva, which can mimic other immunologically mediated inflammatory diseases of the ocular surface 2
Organ-Specific Manifestations
Some organs that can be affected by GVHD include:
- Eyes: ocular GVHD can cause dry eye disease, vision loss, and other symptoms 2
- Skin: GVHD can cause skin manifestations, but the specific details are not provided in the given studies
- Lacrimal gland: GVHD can cause involvement of the lacrimal gland, leading to dry eye disease 2
- Meibomian glands: GVHD can cause involvement of the meibomian glands, leading to dry eye disease 2
- Cornea: GVHD can cause involvement of the cornea, leading to vision loss and other symptoms 2
- Conjunctiva: GVHD can cause involvement of the conjunctiva, leading to dry eye disease and other symptoms 2
Severity of GVHD
The severity of GVHD can vary, and it can be classified as acute or chronic. Acute GVHD can be lethal, and chronic GVHD can cause long-term damage to organs and tissues 3, 4, 5, 2. The severity of GVHD can also affect the treatment outcomes, and a multidisciplinary approach is often necessary to manage the disease 2.