Chronic graft-versus-host disease (GVHD) is a common and potentially life-threatening complication which develops as a result of allogeneic hematopoietic cell transplantation (HCT), when the transplanted cells react against the body of the recipient. The prevalence varies from 25–80% in long-term survivors.
cGVHD can lead to serious physical and functional impairment that affects quality of life as it is often diagnosed late in its course, when disability has already begun.
cGVHD can affect basically any organs, with the most commonly affected sites being: the skin, the mouth, the eyes, the gastrointestinal tract, the muscles and joints, the lungs, the liver, and genitalia. From a musculoskeletal point of view, the main concern for the Allied Health Professionals are:
Manifestations typically appear within the first year after HCT. The most commonly affected joints include fingers, wrists, elbows, shoulders, ankles, and hips, with the distal joints often affected first (anecdotal evidence). cGVHD is an independent risk factor for joint destruction and associated pain and dysfunction.
The number of long-term survivors after allogeneic HCT has been increasing over the past years, and quality of life (QOL) has become an important end-point. The QoL in this patient group can be affected due to:
Decreased range of motion, significantly restricting a patient’s ability to perform activities of daily living.
Painful joint contractures in some patients resulting in impaired function.
Chronic graft versus host disease is an independent risk factor for joint destruction and associated pain and dysfunction.
Some patients also show deteriorated role functioning and global QOL, increased fatigue, and skin problems.
The long-term sexual complications include decreased libido, vaginal alterations, erectile and ejaculatory dysfunctions.
Due to physical dysfunction many patients also struggle to return to work post cGVHD, however, your physical therapist along with the HCT team, will be able to carry out a work-focused physical assessment and advice on return to work.
After having a bone marrow or stem cell transplant, some patients will develop graft versus host disease (GVHD). Graft versus host disease (GVHD) is the term used when this new immune system from the donor attacks your body.
It is difficult to predict before the transplant exactly who will get GVHD and to what extent. When donors are matched to patients, whether related or unrelated donors, laboratory work aims to provide the best match possible. This work can attempt to predict the risk of GVHD and can enable doctors to choose the best available donor for the transplant.
Acute GVHD: In the early weeks and months after your transplant (usually within the first four months) you might notice a rash, or an upset stomach with nausea, vomiting or diarrhea, or it could affect your liver tests, sometimes causing jaundice (yellow discoloration to skin).
Chronic GVHD: Can happen few months after transplant and can reoccur for several years after transplant. Like acute GVHD, it may affect your skin, gut, liver or mouth. But it can also affect other parts of your body, such as your eyes, lungs, vagina and joints. Chronic GVHD may be mild or severe, and for some people can go on for several months or even years.
The most common joints that are affected in GVHD are:
‘’Some GVHD may be a good thing because it means that your new immune system is working and is likely to be attacking any remaining disease cells. This can help stop the disease coming back. You might hear this called graft versus tumour effect’’.
As a patient, it's always good to keep an eye on any changes you notice in the body and make notes, inform the medical team. Although not definite but some early signs might be clawing of the fingers in hand, reduce in ankle movement, skin changes and pain in the joints.
Your doctor can diagnose GVHD from your symptoms, as well as from results of laboratory tests and tissue samples. The early symptoms of GVHD are often the same as some side effects and complications after a transplant, so diagnosing GVHD can be hard. Before your doctor can make a diagnosis, your medical team will first make sure that there are no other reasons for the symptoms.
You can help your medical team by immediately reporting changes in your symptoms or about the onset of new symptoms.