How Can Graft Versus Host Disease be Prevented?

Measures to prevent GVHD

Graft versus host disease (GVHD) is a common complication of any transplant. While it may not be possible to entirely prevent GVHD, there are several ways to reduce the chances of developing GVHD and reducing its severity if it does occur.

• Choosing a well-matched donor: This is perhaps the single most important factor for weighing the chances of developing GVHD. The chances of developing GVHD are highly dependent on the extent of HLA-match between the donor and the recipient. Read more about HLA and HLA matching. The better the HLA match, the lesser the chances of GVHD. Syngeneic transplants (an identical twin as a donor) result in the least chance of GVHD.
• Having a cord blood transplant: A cord blood transplant is an alternative to a bone marrow or a peripheral blood stem cell transplant. Using preserved umbilical cord blood has been shown to result in a lesser chance of GVHD development, and a less severe GVHD than bone marrow or peripheral blood stem cell transplants.
• Using drugs to prevent GVHD: Every individual who gets a transplant is given drugs that potentially prevent GVHD. Methotrexate and cyclosporine are some common examples. They work well for many patients, but others may get GVHD despite getting these medications.
• Removing T-cells from donated blood or marrow: In GVHD, it is the T-cells (a type of white blood cell) in the donor blood that attacks the organs of the transplant recipient. See How does GVHD occur? for a better understanding of the process. There are ways to remove T-cells from the donors blood and marrow before they are put into the patient. This reduces the chances of GVHD. However, for some reasons that are not perfectly understood, this also somewhat diminishes the chances of a successful settling down of the stem cells in the patient. Therefore, it requires a careful evaluation of the risks of GVHD and transplant failure before a decision to remove T-cells can be taken.
• Protecting the skin from UV rays: Too much exposure to the sun is one of the ways that GVHD is triggered. All individuals who get a transplant are advised to wear a sunscreen with a high SPF whenever they go out so that UV rays are blocked. This applies to both sunny and cloudy days.