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Acute Graft Versus Host Disease

Graft versus host disease (GVHD) is a potential complication after allogeneic bone marrow transplant. In GVHD, specific immune cells called T cells in the transplanted bone marrow or stem cells view the recipient’s body as foreign. The transplanted cells produce an immune response and cause damage to different organs of the recipient’s body. Acute GVHD (aGVHD) is seen when the donor’s stem cells begin to engraft in the recipient. This typically occurs within the first 100 days after transplant.

Risk Factors for aGVHD

There are several factors that increase the risk for developing aGVHD. The most important risk factor is how well the recipient and the donor’s bone marrow are matched (HLA match), as well as how much genetic similarity exists outside of the HLA match between the donor and the recipient. For this reason, HLA matched related (usually sibling) donor transplants have the lowest risk of developing aGVHD. HLA mismatched related donor and matched unrelated donor transplants have a higher risk of developing aGVHD. Some Other risk factors for developing aGVHD include differences between the sex of the recipient and donor, older age of donor or recipient, or having a female donor who has been pregnant in the past.

Symptoms of aGVHD

aGVHD can affect the skin, liver and/or gastrointestinal (GI) tract. The most common initial sign of aGVHD is a rash. It often affects the palms of the hands and soles of the feet, but can affect other parts of the body. As the rash worsens, it might develop into general redness that looks like sunburn. The rash may or may not be itchy.

Common symptoms of aGVHD of the GI tract include lack of appetite, nausea, vomiting, stomach cramps, and large amounts of watery diarrhea.

Symptoms of aGVHD of the liver include yellowing of the skin and eyes and abnormal liver lab test values.

Diagnosing aGVHD

aGVHD can be difficult to diagnose. The diagnosis is often made based on the doctor’s exam and laboratory tests. Sometimes a biopsy of the skin or GI tract is necessary to make the diagnosis. Your transplant team will inform you if this is necessary. Once aGVHD is diagnosed, your transplant team will assign a severity score using criteria that have been developed by a national team of aGVHD experts, and he/she will use this to determine the appropriate treatment and to track your response to treatment.

Treatment of aGVHD

Nearly all allogeneic transplant recipients receive some immune suppressive medications to help prevent aGVHD. These medications will help to prevent the new immune system from attacking the recipient's body tissues. Some of these medications are monitored by lab tests to be sure the appropriate dose is being given.

If aGVHD develops after transplant, then high doses of corticosteroids (steroids) will likely be added to the medications your child has received for prevention of aGVHD. Steroids will be decreased slowly as a taper over a long period as the aGVHD symptoms improve. Sometimes, aGVHD symptoms will return (or flare) as the steroids are tapered down, and the dose must be increased again. If aGVHD does not improve with steroids, other medications will be given.

Prognosis for aGVHD

The chance for “curing” aGVHD depends upon the severity of the condition. Sometimes the treatment for aGVHD can lead to severe complications from the immune suppression, including life-threatening infections. For this reason, your child will receive medications to help prevent bacterial, viral, and fungal infections while they are receiving medications to prevent or treat aGVHD.

For more information regarding aGVHD staging and grading, click here.

Medical Disclaimer

The information on the website is intended to introduce you to some of the medical procedures and treatments which you/your child may receive when undergoing a hematopoietic progenitor cell transplant. The information on the website provides general guidelines but cannot replace the recommendations of your primary medical team. Specific patient care treatment options and procedures are the prerogative of each patient and their medical care team. You are encouraged to discuss any concerns or questions you have with your medical care team. Although every attempt has been made to post information that is clear and accurate, no guarantee is made to the reliability, completeness, relevancy, accuracy, or timeliness of the content. No liability is assumed by the Pediatric Blood and Marrow Transplant Consortium for any damages resulting from use or access to information posted on this website.

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