Treatment for acute GvHD

Your doctor assesses your GvHD to decide what treatment you need. The treatment aims to manage your symptoms and treat the GvHD.

Assessing GvHD

Your doctor grades acute GvHD as mild, moderate, severe or very severe. Acute GvHD mainly affects the skin, bowel or liver. 

Your treatment depends on the grade of your GvHD. You might not need any treatment if you have grade 1 (mild) GvHD. But you will need some type of treatment for moderate to severe GvHD. This is grade 2 to grade 4.

General treatments

Treatment is based on drugs that reduce your body’s immune response and reduce the number of T cells . The most common treatment is corticosteroids (usually prednisolone).

Doctors sometimes use a drug called ciclosporin with the steroids. Ciclosporin is also called Deximune, Neoral or Sandimmum. You take it as a tablet. 

Sometimes steroids and ciclosporin do not control GvHD. In this case, your doctor will use other treatments, which may include:

• a type of light therapy called extracorporeal photopheresis (ECP)
• infliximab (Remicade)
• etanercept
• sirolimus
• mycophenolate mofetil (MMF)
• ruxolitinib

Treating acute skin GvHD

The most common treatment for skin GvHD is steroids. Your treatment depends on the grade of GvHD you have.

What you can do to help yourself 

There are some things you can do to help keep your skin more comfortable. For example:

• wear cotton clothes
• try not to get too hot or too cold
• use unperfumed soaps
• use warm, not hot, water for washing
• let your skin dry in the air, or gently pat it dry – don’t rub it
• keep your skin well moisturised with unperfumed creams or lotions
• cover up your skin in the sun

Treating acute gut GvHD

GvHD of the gut might cause sickness or diarrhoea. The main treatment is steroids, which generally work well. Your doctor might also treat you with other drugs to suppress your immune system and so reduce the GvHD. Light therapy with extracorporeal photophoresis can also help.

To control your symptoms you might need:

• fluids by drip into a vein, to prevent and treat dehydration
• painkillers if you have any tummy (abdominal) cramps
• anti sickness drugs if you feel sick
• drugs to control your diarrhoea 
• feeding though a tube into your stomach or directly into your bloodstream, if you can't eat and are losing weight

Once you are able to eat, you start with a diet that is low in fibre, fat and lactose. You should also avoid spicy and acidic foods as they can irritate the gut.

What you can do to help yourself 

There are some things you can do to help with sickness and diarrhoea. These include:

• drinking plenty of fluids – tell your doctor or nurse if you feel sick and find it difficult to drink
• taking anti sickness drugs
• taking the painkillers your nurse gives you
• keeping the area around your back passage clean and dry if you have diarrhoea – you may need a barrier cream to try to prevent the skin getting sore and breaking down

Treating acute liver GvHD

You might not have symptoms of liver GvHD. Your doctors might have picked it up from your regular liver function tests or LFTs (a type of blood test).

GvHD of the liver is graded according to the amount of bilirubin in your blood. Bilirubin is a waste product made when red blood cells break down. A raised bilirubin level in the blood can show that the liver isn’t working properly. The more bilirubin you have, the higher your grade of GvHD will be.

Doctors treat liver GvHD with steroids. They might also give you other drugs to reduce the number of T cells your new bone marrow is making.

If you have symptoms of liver GvHD you might have:

• drugs to relieve itchy, jaundiced skin
• blood transfusions if you have a low red blood cell count (anaemia), or a low platelet count
• painkillers

Your doctor continues to do regular liver function tests to check how the treatment is working. You might need to cut down or stop taking any medicines that are known to affect the liver. Be sure to speak to your doctor about this first though. 

Your doctor might also refer you to a consultant specialising in gut and liver problems (a gastroenterologist).

What you can do to help yourself

There are things you can do to help with liver GvHD symptoms:

• don’t get too cold or too hot – this can make itching worse
• wear cotton instead of man made (synthetic) fabrics like nylon
• take the drugs your doctor or nurse gives you to help with any itching
• take painkillers regularly, as prescribed by your doctor – they work better than if you take them now and again