Causes and risk factors
In an allogenic transplant, the new, transplanted cells regard the recipient’s body as foreign and hence attack it. The donor and recipient are always matched to find as close a match as possible. Closer the match, lower are the chances for development of GVHD. Receiving a transplant from an identical twin is associated with a very low chance of developing GVHD. Receiving a transplant from a relative is associated with a 30-40% chance of developing GVHD. Receiving a transplant from an unrelated person is associated with very high chance [60-80%] of developing GVHD. Marked differences between the ages and gender of the donor and recipient have a higher risk of developing GVHD.
Clinical presentation
The presentation of GVHD may be acute or chronic. People who have undergone transplant are highly susceptible to infections. Acute GVHD usually occurs in the first three months after transplant. The symptoms produced may be mild, moderate, or severe – skin rash with redness and itching. There can be nausea, vomiting, diarrhea. Jaundice can occur. Chronic GVHD usually occurs more than 100 days after the transplant. It usually develops as an extension of acute GVHD, but it sometimes occurs even in people who have not had acute GVHD. Dryness, peeling and ulcers on the skin, feeling of breathlessness, aphthous ulcers, and dry mouth can occur. Sensation of grittiness with dryness of eyes is seen. GI symptoms include nausea with loss of appetite, abdominal cramps, and diarrhea. Susceptibility to recurrent infections occurs. There is dryness of vagina. Muscle aches and joint pains are common.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. Blood tests involve complete blood count, liver function tests, and serum electrolytes. Biopsy of the affected parts is recommended. USG, barium studies of the stomach and abdomen, and endoscopy is done.
Treatment
Treatment involves administration of corticosteroid medicines or immunosuppressive drugs which help to suppress the immune system. Preventive measures against infection such as air filtering equipments, masks, maintenance of good personal hygiene and environment around is necessary for initial period. T cell depletion is helpful in some cases.
Other Modes of treatment
The other modes of treatment can also be effective in treating GVHD. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating GVHD.
