After a bone marrow or stem cell transplant, donor immune cells can sometimes attack the patient’s body. That reaction is graft-versus-host disease (GvHD). It can feel sudden and scary, but knowing the signs and the usual steps doctors take helps you stay in control.
GvHD appears in two main patterns. Acute GvHD usually shows up within the first 100 days after transplant. Chronic GvHD comes later and can act more like an autoimmune condition, lasting months or years. Both can range from mild to life-threatening.
Symptoms depend on which organs are affected. The three most common targets are skin, gut, and liver.
Skin: rash, redness, peeling, or tight, painful skin. Severe cases can blister and look like burns.
Gut: nausea, vomiting, stomach cramps, and especially diarrhea that may be bloody. This causes dehydration and weight loss fairly quickly.
Liver: jaundice (yellow skin or eyes), dark urine, and abnormal liver blood tests. If you notice yellowing, call your team right away.
Other areas can be affected too — mouth sores, dry eyes, lung problems (shortness of breath), and joint stiffness or muscle weakness are possible with chronic GvHD.
Doctors use a mix of exams, blood tests, biopsies, and imaging. A skin or gut biopsy often confirms the diagnosis. Lab tests track organ function and infection risks.
Treatment focuses on controlling the donor immune cells and supporting damaged organs. First-line therapy is usually steroids like prednisone. If steroids don’t work or cause bad side effects, teams often add or switch to drugs such as tacrolimus, cyclosporine, mycophenolate, or newer agents like ruxolitinib.
For chronic GvHD, treatments can include topical creams for skin and eyes, physical therapy for stiffness, and extracorporeal photopheresis (a blood treatment) for stubborn cases. Infection prevention is a big part of care since immunosuppression raises infection risk.
Preventing severe GvHD starts before the transplant. Better donor matching, T-cell manipulation of the graft, and careful immune-suppressing regimens can lower risk. But some GvHD can be linked to a helpful graft-versus-leukemia effect, where donor cells also attack remaining cancer cells — a complicated trade-off your team will balance.
Living with GvHD means regular follow-ups, watching labs, protecting from infections, and focusing on rehab and quality of life. Small daily steps — skin care, eye drops, balanced nutrition, and gentle exercise — add up.
If you notice new rashes, persistent diarrhea, yellowing of skin or eyes, worsening breathing, or sudden fatigue after a transplant, contact your transplant center right away. Early action gives the best chance to control GvHD and keep you moving forward.
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