Information on the following diseases can be found in the Related Disorders section of this report:

• Ulcerative Colitis
• Lichen Planus

The most frequent signs of Graft versus Host Disease (GVHD) occur after a blood transfusion or bone marrow transplant. They are dermatitis (a skin rash), gastrointestinal problems (diarrhea, nausea and abdominal pain) and poor liver function. There may also be involvement of kidneys, lungs, eyes, mouth, musculoskeletal system and heart. GVHD affects about 60% of all bone marrow transplant and transfusion patients whose immune system was suppressed before treatment. Immunosuppression can occur as a result of certain drugs, radiation or certain diseases. Cancer patients and organ transplant recipients often use drugs that suppress their immune systems.

Disorder Subdivisions: Acute GVHD usually occurs in the first 100 days after blood transfusion or bone marrow transplant. The first symptoms are usually mild skin rash, liver dysfunction and intestinal problems, or they may show very severe skin problems, diarrhea, nausea, abdominal pain and liver failure.

Chronic GVHD usually persists long after a transfusion or bone marrow transplant. The signs and symptoms are similar to those of the Acute GVHD, but in addition to the skin, abdomen and liver problems, Chronic GVHD may also involve the eyes, mouth, lungs and musculoskeletal system.

GVHD is caused by the recipient's immune system's response to the lymphoid cells in the donor's blood that react against the recipient's own blood cells. GVHD can be acute (sudden) or chronic (long lasting). In cases of bone marrow transplants the recipient usually undergoes radiation to destroy their own diseased bone marrow, and their immune system is drastically weakened when they receive the donor's bone marrow. Cancer patients undergoing chemotherapy are also at high risk of getting GVHD from blood transfusions.

GVHD affects males and females of all ages who have been immunosuppressed before being given either blood transfusions or bone marrow transplants.

Symptoms of the following disorders can be similar to those of Graft versus Host Disease. Comparisons may be useful for a differential diagnosis:

Lichen Planus is a recurrent, itchy, inflammatory eruption of the skin which is characterized by small separate, angular spots that may join together into rough scaly patches. It is often accompanied by oral lesions. The initial attack persists for weeks or months, and intermittent recurrences may be noted for years. Moderate to severe itching may be present, and it often does not respond to treatment. (For more information on this disorder, choose "Lichen Planus" as your search term in the Rare Disease Database.)

Ulcerative Colitis is an inflammatory disease of the bowel characterized by chronic ulcers in the colon. The chief characteristic of this disorder is bloody diarrhea. Colitis may involve only the left side of the colon or may eventually extend to involve the entire bowel. However, in some cases it may attack most of the large bowel simultaneously. The disease is usually chronic, with repeated periods of exacerbation and remission. (For more information on this disorder, choose "Ulcerative Colitis" as your search term in the Rare Disease Database.)

Treatment of GVHD usually consists of glucocorticoid (steroid) drugs and a combination of cyclosporine (Sandimmune) and methotrexate. In some cases where GVHD is resistant to steroid drugs, treatment with anti-interleukin-2 receptor monoclonal antibody has been used. Treatment is often given to patients before a blood transfusion or bone marrow transplant, or the blood may be treated before being given to the recipient. These methods of pre- treatment often keep GVHD from developing.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, in the main, contact:
www.centerwatch.com

Bennett JC, Plum F., eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, PA: W.B. Saunders Co; 1996: 975.

Jacobsohn DA, Novel therapeutics for the treatment of graft-versus-host disease. Expert Opin Investig Drugs. 2002;11:1271-80.

Carpenter PA, et al., A humanized non-FcR-binding anti-CD3 antibody, visilizumab, for treatment of steroid-refractory acute graft-versus-host disease. Blood. 2002;99:2712-9.

Rivkina AM, Stump LS, Infliximab in graft-versus-host disease. Am J Health Syst Pharm. 2002;59:1271-5.

Deeg HJ, et al., Treatment of steroid-refractory acute graft-versus-host disease with antibody-CD147 monoclonal antibody ABX-CBL. Blood. 2001;98:2052-8.

Greinix HT, et al., Extracorporeal photochemotherapy in the treatment of severe steroid-refractory acute graft-versus-host disease: a pilot study. Blood. 2000;96:2426-31.

McDonald GB, et al., Oral beclomethasone dipropionate for treatment of intestinal graft-versus-host disease: a radonmized, controlled trial. Gastroenterology. 1998;115:28-35. Comment In: Gastroenterology. 1998;115:220-2.

Zic JA, et al., The North American experience with photopheresis. Ther Apher. 1999;3:50-62.

Bonnie C, et al., HSV-TV gene transfer into donor lymphocytes for control of allogeneic graft-versus-leukemia. Science. 1997;276:1719-24.

Chao NJ, et al., Cyclosporine, methotrexate, and prednisone compared with cyclosporine and prednisone for prophylaxis of acute graft-versus-host disease. N Engl J Med. 1993;329:1225-30.

Decoste AD, et al., Transfusion-associated graft-vs-host disease in patients with malignancies. Report of two cases and review of the literature. Arch Dermatol. 1990;126:1324-29.

Martin PJ, et al., A retrospective analysis of therapy for acute graft-vs-host disease: initial treatment. Blood. 1990;76:1464-72.

Jones B, et al., Gastrointestinal inflammation after bone marrow transplantation: graft- vs-host disease or opportunistic infection? AJR Am J Roentgenol. 1988;150:277-81.