Treatment and the treatment process

GVHD

Graft-versus-host disease (GVHD) happens when the donor’s immune cells see the recipient’s tissues as "foreign". It is a common complication of allogeneic transplant.

Last updated: 14 October 2026~2 min read

On a dark navy background, glowing teal donor immune cells approach rose-toned tissue cells, with red sparks where they meet. — **Figure 1.**Donor immune cells react to the recipient’s tissue.

01Short answer

In an allogeneic transplant the new immune system comes from the donor. Donor T cells may recognise the recipient’s cells as foreign and attack them — this is GVHD. Acute GVHD usually appears in the first months as damage to the skin (rash), gut (diarrhoea, tummy pain) and liver (jaundice). Chronic GVHD develops later and can affect the skin, mouth, eyes, lungs, joints and other organs. To prevent it, immunosuppressants are given after transplant (such as ciclosporin or tacrolimus, methotrexate, and sometimes post-transplant cyclophosphamide). Treatment uses steroids and other medicines (such as ruxolitinib). The same donor cells also attack leukemia cells — the "graft-versus-leukemia" effect — so the team looks for a balance.

02Simple explanation

A new immune system. Donor cells start protecting the body.

Mistaken identity. Sometimes they attack healthy tissue too.

Prevention. Medicines calm the immune system.

Balance. The same cells also fight the leukemia.

03Scientific explanation

Mechanism: conditioning causes tissue damage and a cytokine "storm"; donor T cells recognise recipient antigens (HLA and minor antigens), become activated and attack target tissues. In chronic GVHD, B cells and fibrosis play a major role.

Risk factors: HLA mismatch, unrelated donor, female donor to male recipient, peripheral blood graft and older recipient age. Prevention: a calcineurin inhibitor plus methotrexate, post-transplant cyclophosphamide, ATG and others.

Treatment: first-line for acute GVHD is systemic corticosteroids; for steroid-refractory disease, medicines such as ruxolitinib are used. For chronic GVHD: steroids, ruxolitinib, belumosudil, ibrutinib (in some countries) and extracorporeal photopheresis. NIH criteria grade chronic GVHD severity.

04What happens in the body?

What happens?

Donor immune cells notice "foreign" signals in their new body and react. It shows the transplant has created a new immune system, but it needs control.

Which organs?

Acute GVHD mainly affects the skin, gut and liver. The chronic form can involve more organs, such as the mouth, eyes, lungs, joints and skin.

Three elegant abstract shapes for skin, intestine and liver glow gold and teal side by side. — **Figure 2.**Acute GVHD mainly affects the skin, gut and liver.

Balance

Too much immunosuppression raises the risk of infection and relapse; too little opens the door to GVHD. The team adjusts doses using blood tests and how you are.

On a dark background, a scale of light with a teal shield on one side and a small gold spark on the other. — **Figure 3.**The team balances immunosuppression against the anti-leukemia effect.

05Keeping GVHD in check

A simplified outline.

1SkinWatch for rash.

2GutNote diarrhoea.

3MedicinesExactly on schedule.

4ClinicRegular reviews.

Early treatmentBetter control.

BalanceAgainst infection and relapse.

Over timeImmunosuppression is often reduced.

06Acute and chronic GVHD

Feature	Acute	Chronic
When	Usually in the first months	Usually later
Skin	Rash, redness	Dryness, tightening, colour change
Digestion	Diarrhoea, tummy pain	Mouth sores, difficulty swallowing
Liver	Jaundice	Raised enzymes
Other	—	Dry eyes, lungs, joints

* The transplant team makes the diagnosis and plans treatment; sometimes a biopsy is needed.

07Key terms

GVHD: Graft-versus-host disease.
Allogeneic: A graft from a donor.
Immunosuppression: Reducing immune system activity.
Graft-versus-leukemia: Donor cells attacking leukemia cells.
HLA: Molecules that determine tissue matching.
Steroids: Medicines that reduce inflammation.

08Key points

GVHD follows allogeneic transplant.
The acute form affects skin, gut and liver.
The chronic form can involve more organs.
Early detection makes treatment easier.
Take immunosuppressants exactly as prescribed.
Sun protection matters for skin GVHD.

09Frequently asked questions

Does GVHD happen after an autologous transplant?

Almost never, because the cells are your own.

Will GVHD go away?

In many cases treatment brings it under control and it eases over time; the chronic form can last longer.

Why protect myself from the sun?

Ultraviolet light can trigger skin GVHD flares.

What are the side effects of steroids?

Raised blood sugar, infection risk, mood changes and effects on bones; your team monitors these.

10Questions for your doctor

Take these questions to your appointment. The ones you save are collected on the “My questions” page and stay on this device only.

Does GVHD happen after an autologous transplant?
Will GVHD go away?
Why protect myself from the sun?
What are the side effects of steroids?

My questions

12Sources

MedlinePlus. Graft-versus-host disease
National Cancer Institute (NCI). Stem Cell and Bone Marrow Transplants for Cancer
NHS. Stem cell or bone marrow transplants
ICUsteps. Guide to intensive care: glossary of ICU terms
MedlinePlus (U.S. National Library of Medicine). Delirium
Critical Care Medicine, 2018. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Critical Care Medicine, 2017. The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families
National Cancer Institute (NCI). Definition of refractory – NCI Dictionary of Cancer Terms
National Cancer Institute (NCI). Cancer Clinical Trials Information
National Cancer Institute (NCI). Choices for Care with Advanced Cancer

Medical disclaimerThis information is for educational purposes only and does not replace medical advice.

Last updated: 14 October 2026← Back to the list

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