Graft-versus-host disease (GVHD) symptoms can range from mild to severe, and all of them can have an impact on your quality of life in different ways.
The symptoms of acute GVHD, which often occurs within the first few months of a transplant, tend to be mild for most people, says Siddhartha Ganguly, MD, chief of hematology at Houston Methodist Oncology Partners. Usually appearing in the gastrointestinal tract, in the liver, and on the skin, symptoms include abdominal pain, diarrhea, pale urine, and skin rashes.
Chronic GVHD tends to occur more than 100 days after a transplant, and symptoms are also usually mild. But some people are at risk of more serious complications, including lichen planus (sores) in the mouth and an increased risk of infections.
GVHD Symptoms Can Have an Impact on Quality of Life
GVHD can affect multiple organs and body systems, leading to chronic pain, digestive issues, fatigue, skin irritation, and even mouth or vision discomfort. These symptoms make it harder to do even basic tasks, such as eating or walking. They can also be emotionally taxing, even leading to anxiety and depression, says Manish Gandhi, MD, a pathologist and the medical director of the transfusion laboratory at Mayo Clinic in Rochester, Minnesota.
The good news: “There are treatments and ways to manage symptoms to help improve quality of life,” says Dr. Gandhi.
13 of the Best Foods for Chronic GVHD
Easy to digest and packed with nutrients to aid recovery and manage symptoms, these 13 foods are some of the best for managing GVHD.
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How to Manage GVHD Symptoms
The key to managing and staying on top of the many possible symptoms of GVHD is to work closely with your care team, which will likely include a range of specialists. “We take quality of life very seriously and try to do as much as we can to support these patients,” says Dr. Ganguly. “It’s a holistic approach: We look after eye health, oral health, skin health, and mental health, too.”
Working closely with your care team can help your doctors determine if symptoms are due to GVHD itself, treatments for GVHD, or another condition that may have appeared in the meantime.
At home, here’s what you can do to ease symptoms and start feeling better.
Use a moisturizer or topical steroid on your skin. The symptoms of GVHD tend to appear on the skin first, often as itchiness, rashes, or skin tightness. If you have chronic GVHD, you may also notice your skin starting to harden. “This can be treated through topical management — ointments and creams — and system management like corticosteroids,” says Ganguly.
Wear sunscreen every day. If you have GVHD, you’re at increased risk of skin cancer due to treatments that can weaken the immune system’s ability to repair or destroy sun-damaged cells.
Do stretching exercises. If you have stiff, painful joints, try doing some stretching and gentle exercises to improve joint flexibility. Your doctor (or a physical therapist) may recommend doing specific movements, such as hamstring stretches, neck rotations, or shoulder rolls, but always talk to your healthcare provider before trying anything on your own.
Eat smaller meals, more often. GVHD can cause diarrhea, difficulty absorbing nutrients, or nausea. “Eating small, frequent meals of healthy foods, avoiding spicy or acidic foods, and drinking plenty of water can help manage these symptoms,” says Gandhi. Your doctor may also prescribe medication to reduce gut inflammation.
Use eye drops. GVHD can attack the glands that produce tears and saliva, leading to dryness. Ask your doctor if you’re a candidate for cyclosporine, natural tear, or serum eye drops. Scleral contact lenses, which are specifically made to treat dry eye, can also help keep eyes moisturized, says Ganguly.
Pace yourself. Since GVHD can send your immune system into overdrive, you may feel especially fatigued. (Plus, it’s a side effect of using steroids.) To conserve as much energy as possible, try eating healthy foods that provide plenty of energy throughout the day, pacing your activities, and sticking to a regular sleep schedule. If steroids are contributing to your fatigue, your doctor may prescribe steroid-sparing medications that make it possible to keep your steroid dose as low as possible.
Talk to a therapist. Living with GVHD can be overwhelming, so it’s unsurprising that some people with the condition develop anxiety or depression. “The first thing you need to understand is that you’re not alone,” says Ganguly. Talking to a mental health professional, joining a support group, or practicing stress-relief techniques, such as meditation, can help boost your mental health. You may also want to talk to your doctor or a psychiatrist about prescribing an antidepressant or mood stabilizer.
Avoid alcohol, and if you smoke, stop. GVHD can damage the liver and lungs, causing jaundice or trouble breathing. Drinking alcohol and smoking can further harm the lungs and liver, as well as hamper the immune system and interfere with the effectiveness of certain medications.
Even if you’re able to successfully manage symptoms on your own, be sure to stay in regular contact with your doctor and keep yourself up to date with checkups. “Regular checkups are important to catch any developing symptoms early,” says Gandhi.
In some cases, your transplant doctor may refer you to a specialist, such as a dermatologist for skin problems, a physical therapist for deeper tissue symptoms, or a dentist for mouth symptoms. Together, your providers can prescribe treatments that can help you keep symptoms in check.
The Takeaway
It’s common to experience symptoms of GVHD after a bone marrow or stem cell transplant. Symptoms can range from mild to severe and can occur immediately after surgery or months after the procedure.
GVHD can affect different areas of the body, as well as emotional health.
Work closely with your GVHD care team to monitor and treat any symptoms. This will help you heal and improve your overall quality of life.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Justiz Vaillant AA et al. Graft-Versus-Host Disease. StatPearls. June 7, 2024.
Pugliese S. Graft-Versus-Host Disease: How It Affects Skin, Nails and Hair. BMT InfoNet. May 2, 2024.
Redondo S et al. Efficacy and Safety of Ruxolitinib in Steroid-Refractory/Dependent Chronic Graft-Versus-Host Disease: Real-World Data and Challenges. Transplantation and Cellular Therapy. January 2022.
Shah R et al. Multidisciplinary Management of Morbidities Associated With Chronic Graft-Versus-Host Disease. Clinical Hematology International. October 21, 2024.
Conor E. Steuer, MD, is medical oncologist specializing in the care of aerodigestive cancers, mesothelioma, and thymic malignancies and an assistant professor in the department of hematology and medical oncology at the Emory University School of Medicine in Atlanta. He joined the clinical staff at Emory's Winship Cancer Institute as a practicing physician in July 2015. He currently serves as chair of the Lung and Aerodigestive Malignancies Working Group and is a member of the Discovery and Developmental Therapeutics Research Program at Winship.
Dr. Steuer received his medical degree from the New York University School of Medicine in 2009. He completed his postdoctoral training as a fellow in the department of hematology and medical oncology at the Emory University School of Medicine, where he was chief fellow in his final year.
He has been active in research including in clinical trial development, database analyses, and investigation of molecular biomarkers. He is interested in investigating the molecular biology and genomics of thoracic and head and neck tumors in order to be able to further the care of these patient populations. Additionally, he has taken an interest in utilizing national databases to perform clinical outcomes research, as well as further investigate rare forms of thoracic cancers.
Steuer's work has been published in many leading journals, such as Cancer, the Journal of Thoracic Oncology, and Lung Cancer, and has been presented at multiple international conferences.
Erica Patino is a freelance writer and editor, content strategist, and usability specialist who has worked for a variety of online health outlets, including Healthline, Sharecare, and Twill Care. She was previously a senior editor at Everyday Health. She is also the founder and editor-in-chief of Hear 2 Tell, a website that covers advances in hearing loss treatment. Patino lives in Portland, Oregon, with her husband and twin sons.
