GVHD symptoms

This page tells you about symptoms of graft versus host disease (GVHD). The symptoms depend on the type of GVHD and the parts of your body it affects. There is information about

• Symptoms of acute GVHD
• Symptoms of chronic GVHD
• Checking for symptoms

Acute graft versus host disease happens within the first 100 days after bone marrow or stem cell transplant. Sometimes it can be hard to tell if the symptoms are caused by GVHD, or are other side effects of your transplant. Symptoms of GVHD depend on which part of the body is affected. There is information below about

• Acute skin GVHD
• Acute liver GVHD
• Acute gut (digestive system) GVHD
• Other symptoms

Acute skin GVHD

This usually begins with a rash, often on the palms of your hands or soles of your feet, or on your shoulders. It can become widespread. The rash might be itchy and painful. If it is bad, your skin might blister and peel.

Acute liver GVHD

Your doctor will arrange for you to have regular blood tests, called liver function tests. These tests can pick up early changes in your liver before you get any symptoms. If the GVHD carries on, your skin and the whites of your eyes may look yellow. This is called jaundice. It can also make your skin itchy. Your abdomen may become swollen and painful if your liver becomes enlarged.

Acute gut (digestive system) GVHD

GVHD of the digestive system often starts with diarrhoea. This can be green and watery, and may look ‘bitty’. It sometimes contains mucus and blood. You might have cramping abdominal pain. If GVHD affects your stomach you might have indigestion, feel sick, and lose your appetite.

Other symptoms

Other general symptoms of acute GVHD can include

• Low red blood cells (anaemia)
• Being more prone to infections
• Low grade fever

Chronic GVHD may be mild or severe. Symptoms can be similar to those of acute GVHD. Mainly, chronic GVHD affects your skin and digestive system, including the liver. It can also involve other organs and your immune system, making you more prone to infections.

Chronic GVHD affects the body’s connective tissues. As these are everywhere in the body, it can be widespread. Symptoms vary from person to person, depending on the part of the body affected. There is information below on

• Chronic skin GVHD
• Chronic gut GVHD
• Chronic GVHD of the eyes
• Chronic lung GVHD
• Chronic GVHD affecting the tendons

Chronic skin GVHD

You may develop a rash. Or your skin might feel dry and tight, or itchy. It may look a darker colour. Your skin may thicken and feel ‘bumpy’. Chronic GVHD can also affect your hair and nails. You may find that you are losing hair, and that it turns grey. Your nails might become hard and brittle.

Chronic gut GVHD

As with acute GVHD, chronic GVHD can involve your digestive system. With chronic GVHD you can have diarrhoea that goes on for more than a few days (chronic diarrhoea). Chronic GVHD can also affect your mouth and food pipe (oesophagus). You may find that your mouth is sore and dry. This is because GVHD affects the glands that make your saliva. It is sometimes painful to swallow. Spicy and acidic foods may cause you pain or irritation.

GVHD can affect the lining of your stomach and bowel. So you may not be absorbing the nutrients you need from your food. You may not feel like eating, which can lead to weight loss. You might feel bloated and get stomach cramps. You will be more vulnerable to infections like thrush, or cold sores.

Chronic GVHD can also cause damage and scarring of your liver (cirrhosis). This can stop your liver working properly.

Chronic GVHD of the eyes

If GVHD affects the glands that make tears, your eyes may become dry and painful. Sometimes your eyes feel like they’re burning, and it can be hard to tolerate bright light.

Chronic lung GVHD

You may be short of breath and wheeze when you breathe. You may also have a persistent cough, and be more prone to chest infections.

Chronic GVHD affecting the tendons

Tendons connect muscle to bone. If GVHD affects your tendons you may have difficulty straightening or bending your arms and legs. This is because the tendons can become inflamed and cause your muscles to shorten (contract).

The doctors and nurses who look after you will keep a very close watch for any symptoms of GVHD. Once you are at home they will ask you to report any new symptoms, and check you over each time you come to clinic. If your doctor suspects you may have GVHD, you will have some tests and treatment for GVHD if you need it.