Coping with a Serious Complication of Allogeneic Stem Cell Transplantation – Acute Graft-Versus-Host Disease
(BPT) - Sponsored by Incyte Corporation
Allogeneic transplantation, a type of stem cell transplant that uses stem cells from a donor, is an important part of treatment for certain cancers, most commonly those that affect the blood or immune system. While the procedure has the potential to cure disease and transform cancer patients’ lives, the onset of a little known condition called graft-versus-host-disease (GVHD) can significantly impact their prognosis.1
There are significant challenges living with a rare disease like GVHD, which can range in severity from mild or moderate to life-threatening, and can often be difficult to diagnose.2 That is why raising awareness for and educating people about GVHD in advance of a stem cell transplant is critical to improving the treatment journey for transplant recipients.
What is acute GVHD?
GVHD occurs when healthy donated cells begin to see the patient’s body as unfamiliar and foreign, triggering an immune response to attack the patient’s organs.1 There are two major forms of GVHD, acute and chronic, both affecting different organs and tissues.2 Although acute GVHD can occur any time after a transplant, it is commonly diagnosed within the first 100 days, and is classified based on a physical examination, endoscopy or colonoscopy.3,4,5
Acute GVHD is a life-threatening complication that can occur in up to 70 percent of patients, making it especially important to be aware of the risk factors associated with this disease.6 The likelihood of developing acute GVHD may be higher in older patients or donors, patients whose transplanted cells came from an unrelated or mismatched donor, male patients whose transplanted cells came from female donors (especially females who have given birth more than once), or patients whose transplanted stem cells came from peripheral blood or bone marrow instead of cord blood, or certain conditioning regimens.7
Recognizing Symptoms
Acute GVHD can affect multiple organ systems including the skin, gastrointestinal (digestive) tract and liver. The most common symptoms may include a rash, blisters on the skin, abdominal cramps, diarrhea, nausea, vomiting and yellowing of the skin or eyes.2
It’s important to consult with your transplant team and doctor right away if you notice these symptoms are present. Early detection of symptoms can make a big difference in treatment and preventing permanent organ damage.
Acute GVHD is commonly treated with corticosteroids, but about half of patients who develop this form of GVHD do not respond adequately to treatment, making it an extremely challenging disease to treat.8 When acute GVHD does not respond adequately to steroids, patients can develop steroid-refractory acute GVHD, which can progress to severe disease with a one-year mortality rate of approximately 70 percent.9,10 There remains a need for more effective treatment options.
Finding the Support and Strength You Need
Your transplant care team is familiar with GVHD and it’s important to educate yourself, ask questions and maintain good communication throughout the treatment process. This was the case for Meredith Cowden, a cancer survivor who now lives with the after-effects of a transplant and developing GVHD. “Self-advocacy during the treatment process is, undeniably, one of the most important aspects of the transplant journey,” says Meredith. “Understanding and knowing how to advocate for your health will give you a voice to express symptoms and concerns, enabling you to receive the best quality care.”
Since GVHD is not well known and everyone's experience with GVHD is different, it’s also important to find and connect with the right support groups and people who identify with your experience. “People with GVHD search high and low for each other to gain a sense of perspective and normalcy,” says Meredith. “Finding and connecting with others who can identify with this experience, as well as people who have had this experience and moved past it, creates hope and meaning. Self-advocacy and finding the right support system creates the resilience that will move a person from someone who identifies as a transplant patient to one who identifies as a transplant survivor, onto someone who is thriving in life.”
Visit the Meredith A. Cowden Foundation and The Leukemia & Lymphoma Society to learn more, find helpful tools and resources, and connect with others living with GVHD.*
* Organizations have received funding from Incyte Corporation.
References
1. Types of Stem Cell Transplants for Cancer Treatment. American Cancer Society. https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant.html. Accessed January 2020.
2. Graft-Versus-Host Disease. Leukemia & Lymphoma Society. http://www.lls.org/treatment/types-of-treatment/stem-cell-transplantation/graft-versus-host-disease. Published February 26, 2015. Accessed January 2020.
3. Dignan FL, et al. Diagnosis and management of acute graft-versus-host disease. Br. J. Haematol. 2012;158(1):30-45.
4. Nassereddine S, et al. Acute graft versus host disease: a comprehensive review. Anticancer Res. 2017;37(4):1547-1555.
5. Chao NJ, et al. Clinical manifestations, diagnosis, and grading of acute graft-versus-host disease. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-grading-of-acute-graft-versus-host-disease. Accessed February 2020.
6. Hill L, et al. New and emerging therapies for acute and chronic graft versus host disease. Ther Adv Hematol. 2018;9(1):21–46.
7. Jacobsohn DA, et al. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2:35.
8. Garnett C, et al. Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol. 2013;4(6):366-378.
9. Shapira MY, et al. Regional intra-arterial steroid treatment in 120 patients with steroid-resistant or -dependent GvHD. Bone Marrow Transplant. 2017;52(10);1416-1422.
10. Xhaard A, et al. Steroid-Refractory Acute GVHD: Lack of Long-Term Improved Survival Using New Generation Anticytokine Treatment. Biol Blood Marrow Transplant. 2012;18(3):406-413.
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