Graft-versus-Host Disease

Graft-versus-host disease is a reaction of the immune system that can occur after a patient has received a bone marrow or stem cell transplant. This results in an immune response of the transplanted immunocompetent cells of the donor against the organs of the recipient, which can lead to chronic inflammatory processes. The inflammation mainly affects the internal organs, such as the lungs, liver and intestines, but it can also affect the skin.
There are two basic forms of GvHD, depending on when it occurs: 

  • Acute GvHD occurs directly after the transplant and patients recover fully without any after effects.
  • Chronic GvHD occurs after a delay of several months after the transplant and is long term.

The recipient’s body recognises the white blood cells of the immune system of the donor that remain within the donated tissue as foreign. The white blood cells in the donated tissue then attack the cells of the recipient, which leads to GvHD.



The symptoms primarily depend on the organ affected. Common symptoms include inflammatory reactions in all organs, sometimes accompanied by a high temperature, as well as skin rashes, inflammation of the mucous membranes of the digestive tract and disruptions to liver function.

In the case of acute GvHD, changes to the skin occur that are accompanied by itching and the skin turns yellow (jaundice). Patients often have bowel problems, usually in the form of watery diarrhoea.

Patients with chronic GvHD often also suffer from a shortness of breath, pain in their joints and changes in their mucous membranes.

To ensure the condition is treated as early as possible, it is essential for patients to check themselves regularly, even several months after the transplant. Patients should pay attention to these symptoms:

Scalp and skin:
- Repeated hair loss
- Very flaky and dry scalp
- Flaky and dry skin
- Itchy, rough skin
- Skin redness with and without itching
- Persistent skin rash that looks like goosebumps
- Increased pigmentation in some areas
- Lack of pigmentation in some areas
- Persistent itching without any visible changes

- Feeling a foreign object is present in eye
- Watery eyes
- Burning sensation
- Increased sensitivity to light
- Itching
- Increased irritation
- Redness

Oral mucous membranes:
- Ulcers on the mucous membranes on the cheek
- Burning, pain or discomfort after eating or cleaning your teeth
- Restricted ability to fully open the mouth
- Dry mucous membranes
- Painful blisters on the soft palate after eating

Liver and intestines:
- Yellowing of the whites of the eyes (jaundice)
- Symptoms of hepatitis
- Vomiting (or nausea) lasting longer than 12 hours
- Diarrhoea lasting longer than 12 hours
- Both with or without stomach pain

Joints and tendons:
- Limited flexibility of the joints
- Limited movement of the joints
- Painful joints
- Pain when starting to move after periods of rest

- Dryness
- Changes to the skin
- Flaking
- Pain, burning and discomfort when passing water and during intercourse

Treatment of graft-versus-host disease depends on the severity of the condition. Medication that suppress the body’s immune reaction is used for prevention and treatment. The aim of these immunosuppressive drugs is to help to restore the balance of the immune system. This form of immunotherapy means that patients at DZI and its participating hospitals at Universitätsklinikum Erlangen receive one of the most up-to-date treatment options available.

In the case of acute GvHD, patients receive high dosages of corticosteroids and immunosuppressive drugs in order to suppress the function of the immune system and prevent further excessive immune reactions.

Patients with chronic GvHD also receive immunotherapy in the form of medication such as prednisolone, tacrolimus or ciclosporin A. These drugs have a suppressive effect on the immune system in chronic cases of the disease.

In addition, the Department of Medicine 5 – Haematology and Oncology at Universitätsklinikum Erlangen can provide treatment using extracorporeal photopheresis (ECP) in certain situations. This special type of dialysis involves charging the patient’s leukocytes outside the body with a UV sensitiser before they are exposed to UV light and reintroduced into the patient’s body. The aim is to deactivate particularly active immune cells. Patients who fulfil certain criteria can also participate in clinical trials.

Do you have any questions on the treatment of graft-versus-host disease? Please feel free to get in touch with us by phone, e-mail or via our contact form.