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Over-the-Counter Therapies
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In addition to treating GvHD, immunosuppressants are typically prescribed before or after a transplant to prevent the development of GvHD.
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There are no home remedies that can treat GvHD, but there are things you can do to better manage the symptoms of a condition that affects 50% to 80% of allogeneic (donor-to-recipient) bone marrow or stem cell transplants.
GvHD commonly affects the skin and gastrointestinal tract, both in the people with acute GvHD (occurring within 100 days of a transplant) and those with chronic GvHD (occurring 100 days or more after a transplant).
Though immunosuppressant drugs are the primary forms of treatment, daily skin care, diet, and oral hygiene can go a long way toward better managing the cutaneous (skin) and gastrointestinal symptoms of the disease.
What to Expect From an Autologous Stem Cell Transplant
Skin Symptoms
With chronic GvHD, the skin can often undergo significant changes, with the progressive tightening and hardening of the skin similar to that ofscleroderma. To better manage symptoms ofichthyosis(dry, scaly skin) andcutaneous sclerosis, doctors will recommend frequent moisturizing with anemollient-rich lotion or cream.
The moisturizer will typically be applied before topical medications and can help reducefolliculitiscommon in people with cutaneous GvHD.
Moisturizers are best applied after bathing and throughout the day whenever the skin feels itchy or chafed. Both affected and unaffected skin should be moisturized, the practice of which may temper the progression of cutaneous symptoms.
Gastrointestinal Symptoms
Oral Symptoms
People with chronic gastrointestinal GvHD are also prone to mucosal inflammation and damage of the mouth, gums, and salivary glands, leading toxerostomia(dry mouth),gingivitis, and other potentially severe oral diseases. These problems can be minimized with good oral hygiene, including dailybrushingandflossing, and regular dental cleanings at least twice annually.
Toothpastesshould be free of sodium lauryl sulfate, a foaming agent that can strip oils from mucosal tissues.Mouthwashesshould be unflavored and alcohol-free. To help ease mouth pain, avoid spicy, acidic, coarse, or inordinately hot or cold foods.
Cigarette smokingshould also be stopped. People who have undergone an allogeneic stem cell transplant are seven to nine times more likely to developoral cancercompared to the general public, particularly those with chronic oral GvHD. Smoking only amplifies the risk.
What Is Graft-Versus-Host Disease?
There are several OTC remedies that can aid in the management of GvHD symptoms, although they are rarely if ever used on their own. These include:
OTC medications aid in the symptomatic treatment of GvHD but do nothing to temper the underlyingautoimmune-like effectsof the disease.
Corticosteroids
When applied to the skin or delivered into the bloodstream, corticosteroids “trick” the body into thinking that there are ample supplies of cortisol. As a result, the overactive immune response is blunted, and the inflammatory symptoms are relieved.
Based on the grade of GvHD—ranging from 1 for mild disease to 4 for life-threatening disease—the corticosteroid drug may be delivered topically or systemically. Acute grade 1 GvHD may only require topical steroids. All other grades, either acute or chronic, are typically treated with oral or intravenous steroids.
The two most common systemic corticosteroids used in the treatment of GvHD are:
Systemic steroidsare typically prescribed at a starting dose of anywhere from 1 milligram per kilogram of body weight per day (mg/kg/day) to 10 mg/kg/day depending on the location and severity of symptoms.
Once the symptoms are controlled, the corticosteroid dose isgradually taperedto avoid long-term complications, includingcataracts,glaucoma,type 2 diabetes,osteoporosis, slow wound healing, increased risk of infection, andadrenal insufficiency. In some cases, the corticosteroid can be stopped if remission is achieved; in others, maintenance therapy may be needed.
Even a low-potencytopical steroidmay need to be tapered to prevent irreversible skin thinning and discoloration. Depending on the dose and duration of treatment, the tapering period can take weeks or months.
Other Immunosuppressants
As effective as corticosteroids are in reining in the symptoms of GvHD, they don’t work forever. Not only are steroids stopped when the risks outweigh the benefits of treatment, but they may also stop working as the body develops a gradual resistance to them.
Referred to as steroid-refractory GvHD, this effect can occur in people with acute or chronic GvHD. In cases like these, other immunosuppressive drugs may be prescribed, either alone or in combination. Each has different indications for use, mechanisms of action, and risks.
What to Expect From a Bone Marrow Transplant
Prophylactic Therapy
Immunosuppressants are not only used to treat GvHD but to prevent it as well. Unless you received a transplant from an identical twin, some form of prophylactic (preventive) therapy will be needed.
In addition to drugs commonly used to treat GvHD (such as prednisone and methotrexate), there are two other immunosuppressants that can aid in the prevention of GvHD, calledPrograf (tacrolimus)and Sandimmune (cyclosporine).
Surgeries and Specialist-Driven Procedures
Although immunosuppressants are the cornerstone of GvHD treatment, specialist procedures are sometimes used for people with high-grade GvHD or specific manifestations of chronic GvHD.
Extracorporeal Photophoresis
Extracorporeal photopheresis combines two procedures known asleukapheresisand photodynamic therapy. This involves the removal ofwhite blood cellsfrom the blood, which are then exposed to ultraviolet (UV) radiation before being re-infused back into the body.
The treatment tempers theautoimmune-like activity of the white blood cells, significantly reducing skin, liver, and gastrointestinal symptoms of GvHD.
Phototherapy
The procedure is sometimes used with a photosensitizing agent called psoralen that enhances the effects of theUVA radiation(referred to aPUVA therapy).
A 2018 study in the journalBone Marrow Transplantationreported the PUVA therapy delivered sustained remission in 70% of people with cutaneous GvHD after 31 months.
Surgery
Surgery is sometimes indicated for people with chronic GvHD, most often to repair intestinal, eye, liver, joint, kidney, or heart damage caused the disease.
There are also surgeries that can preemptively treat a complication of GvHD and restore normal function. One such example ispunctal occlusion, a minimally invasive procedure use to open a blocked tear duct to remedy dry eye syndrome.
Other surgeries may be needed to treatspinal stenosis,pericarditis,bile duct obstruction, and other complications of chronic GvHD.
18 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Justiz Valliant AA, Modi P, Mohammadi O.Graft versus host disease. StatPearls.National Health Service (UK).Guidelines for diagnosis and management of cutaneous graft-versus-host disease.Koç N, Gündüz M, Azık MF, et al.Stepwise diet management in pediatric gastrointestinal graft versus host disease.Turk J Pediatr. 2016;58(2):145-51. doi:10.24953/turkjped.2016.02.004Treister N, Duncan C, Cutler C, Lehmann L.How we treat oral chronic graft-versus-host disease.Blood.2012;120(17):3407-18. doi:10.1182/blood-2012-05-393389Hashimoto K, Nagao T, Koie S, Miyabe S, Saito T.Secondary squamous cell carcinoma of the tongue complicated with bronchiolitis obliterans as a manifestation of graft-versus-host disease following peripheral blood stem cell transplantation.Case Rep Hematol.2019;2019:6015803. doi:10.1155/2019/6015803Sanz-Narco E, Udaondo P, García-Delpech S, Vazquez A, Diaz-Ilopis M.Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.J Ocul Pharmacol Ther.2013;29(8):776-83. doi:10.1089/jop.2012.0265Roddy JV, Haverkos BM, Mcbride A, et al.Tocilizumab for steroid refractory acute graft-versus-host disease.Leuk Lymphoma. 2016;57(1):81-5. doi:10.3109/10428194.2015.1045896Meier JK, Wolff D, Pavletic S, et al.Oral chronic graft-versus-host disease: Report from the International Consensus Conference on clinical practice in cGVHD.Clin Oral Invest.2011;15:127-39. doi:10.1007/s00784-010-0450-6Kim YJ, Lee GH, Kwong BY, Martires KJ.Evidence-based, skin-directed treatments for cutaneous chronic graft-versus-host disease.Cureus.2019;11(12):e6462. doi:10.7759/cureus.6462Arora M, Klein JP, Weisdorf DJ, et al.Chronic GVHD risk score: A Center for International Blood and Marrow Transplant Research analysis.Blood. 2011;117(24):6714-20. doi:10.1182/blood-2010-12-323824Garnett C, Apperley JF, Pavlů J.Treatment and management of graft-versus-host disease: improving response and survival.Ther Adv Hematol. 2013;4(6):366-78. doi:10.1177/2040620713489842Ram R, Storb R.Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future.Leuk Lymphoma.2013;54(8):1591-601. doi:10.3109/10428194.2012.762978Hart JW, Shiue LH, Shpall EJ, Alousi AM.Extracorporeal photopheresis in the treatment of graft-versus-host disease: Evidence and opinion.Ther Adv Hematol. 2013;4(5):320-34. doi:10.1177/2040620713490316George L, Peter D, Chopra M, et al.Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience.Bone Marrow Transplant.2016;51:988-90. doi:10.1038/bmt.2016.13Feldreich N, Ringden O, Emtestam L, Omazic B.Photochemotherapy of cutaneous graft-versus-host disease may reduce concomitant visceral disease.Dermatology(Basel). 2016;232(4):453-63. doi:10.1159/000447058Gutierrez CA, Raval MV, Vester HR, Chaudhury S, Von Allmen D, Rothstein DH.Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature.J Pediatr Surg. 2017;52(11):1718-1722. doi:10.1016/j.jpedsurg.2017.06.022Montenegro D.Management of ocular GvHD. In: EyeWiki (American Academy of Ophthalmology).Van Dam N, Zelker R, Radiano R, Kadmon I, Bogorochin B, Frank-Kamenetsky Y.Vulvar and vaginal graft versus host disease: A healthcare clinic initiative.Asia Pac J Oncol Nurs.2017;4(2):116-9. doi:10.4103/apjon.apjon_6_17
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Justiz Valliant AA, Modi P, Mohammadi O.Graft versus host disease. StatPearls.National Health Service (UK).Guidelines for diagnosis and management of cutaneous graft-versus-host disease.Koç N, Gündüz M, Azık MF, et al.Stepwise diet management in pediatric gastrointestinal graft versus host disease.Turk J Pediatr. 2016;58(2):145-51. doi:10.24953/turkjped.2016.02.004Treister N, Duncan C, Cutler C, Lehmann L.How we treat oral chronic graft-versus-host disease.Blood.2012;120(17):3407-18. doi:10.1182/blood-2012-05-393389Hashimoto K, Nagao T, Koie S, Miyabe S, Saito T.Secondary squamous cell carcinoma of the tongue complicated with bronchiolitis obliterans as a manifestation of graft-versus-host disease following peripheral blood stem cell transplantation.Case Rep Hematol.2019;2019:6015803. doi:10.1155/2019/6015803Sanz-Narco E, Udaondo P, García-Delpech S, Vazquez A, Diaz-Ilopis M.Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.J Ocul Pharmacol Ther.2013;29(8):776-83. doi:10.1089/jop.2012.0265Roddy JV, Haverkos BM, Mcbride A, et al.Tocilizumab for steroid refractory acute graft-versus-host disease.Leuk Lymphoma. 2016;57(1):81-5. doi:10.3109/10428194.2015.1045896Meier JK, Wolff D, Pavletic S, et al.Oral chronic graft-versus-host disease: Report from the International Consensus Conference on clinical practice in cGVHD.Clin Oral Invest.2011;15:127-39. doi:10.1007/s00784-010-0450-6Kim YJ, Lee GH, Kwong BY, Martires KJ.Evidence-based, skin-directed treatments for cutaneous chronic graft-versus-host disease.Cureus.2019;11(12):e6462. doi:10.7759/cureus.6462Arora M, Klein JP, Weisdorf DJ, et al.Chronic GVHD risk score: A Center for International Blood and Marrow Transplant Research analysis.Blood. 2011;117(24):6714-20. doi:10.1182/blood-2010-12-323824Garnett C, Apperley JF, Pavlů J.Treatment and management of graft-versus-host disease: improving response and survival.Ther Adv Hematol. 2013;4(6):366-78. doi:10.1177/2040620713489842Ram R, Storb R.Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future.Leuk Lymphoma.2013;54(8):1591-601. doi:10.3109/10428194.2012.762978Hart JW, Shiue LH, Shpall EJ, Alousi AM.Extracorporeal photopheresis in the treatment of graft-versus-host disease: Evidence and opinion.Ther Adv Hematol. 2013;4(5):320-34. doi:10.1177/2040620713490316George L, Peter D, Chopra M, et al.Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience.Bone Marrow Transplant.2016;51:988-90. doi:10.1038/bmt.2016.13Feldreich N, Ringden O, Emtestam L, Omazic B.Photochemotherapy of cutaneous graft-versus-host disease may reduce concomitant visceral disease.Dermatology(Basel). 2016;232(4):453-63. doi:10.1159/000447058Gutierrez CA, Raval MV, Vester HR, Chaudhury S, Von Allmen D, Rothstein DH.Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature.J Pediatr Surg. 2017;52(11):1718-1722. doi:10.1016/j.jpedsurg.2017.06.022Montenegro D.Management of ocular GvHD. In: EyeWiki (American Academy of Ophthalmology).Van Dam N, Zelker R, Radiano R, Kadmon I, Bogorochin B, Frank-Kamenetsky Y.Vulvar and vaginal graft versus host disease: A healthcare clinic initiative.Asia Pac J Oncol Nurs.2017;4(2):116-9. doi:10.4103/apjon.apjon_6_17
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Justiz Valliant AA, Modi P, Mohammadi O.Graft versus host disease. StatPearls.National Health Service (UK).Guidelines for diagnosis and management of cutaneous graft-versus-host disease.Koç N, Gündüz M, Azık MF, et al.Stepwise diet management in pediatric gastrointestinal graft versus host disease.Turk J Pediatr. 2016;58(2):145-51. doi:10.24953/turkjped.2016.02.004Treister N, Duncan C, Cutler C, Lehmann L.How we treat oral chronic graft-versus-host disease.Blood.2012;120(17):3407-18. doi:10.1182/blood-2012-05-393389Hashimoto K, Nagao T, Koie S, Miyabe S, Saito T.Secondary squamous cell carcinoma of the tongue complicated with bronchiolitis obliterans as a manifestation of graft-versus-host disease following peripheral blood stem cell transplantation.Case Rep Hematol.2019;2019:6015803. doi:10.1155/2019/6015803Sanz-Narco E, Udaondo P, García-Delpech S, Vazquez A, Diaz-Ilopis M.Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.J Ocul Pharmacol Ther.2013;29(8):776-83. doi:10.1089/jop.2012.0265Roddy JV, Haverkos BM, Mcbride A, et al.Tocilizumab for steroid refractory acute graft-versus-host disease.Leuk Lymphoma. 2016;57(1):81-5. doi:10.3109/10428194.2015.1045896Meier JK, Wolff D, Pavletic S, et al.Oral chronic graft-versus-host disease: Report from the International Consensus Conference on clinical practice in cGVHD.Clin Oral Invest.2011;15:127-39. doi:10.1007/s00784-010-0450-6Kim YJ, Lee GH, Kwong BY, Martires KJ.Evidence-based, skin-directed treatments for cutaneous chronic graft-versus-host disease.Cureus.2019;11(12):e6462. doi:10.7759/cureus.6462Arora M, Klein JP, Weisdorf DJ, et al.Chronic GVHD risk score: A Center for International Blood and Marrow Transplant Research analysis.Blood. 2011;117(24):6714-20. doi:10.1182/blood-2010-12-323824Garnett C, Apperley JF, Pavlů J.Treatment and management of graft-versus-host disease: improving response and survival.Ther Adv Hematol. 2013;4(6):366-78. doi:10.1177/2040620713489842Ram R, Storb R.Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future.Leuk Lymphoma.2013;54(8):1591-601. doi:10.3109/10428194.2012.762978Hart JW, Shiue LH, Shpall EJ, Alousi AM.Extracorporeal photopheresis in the treatment of graft-versus-host disease: Evidence and opinion.Ther Adv Hematol. 2013;4(5):320-34. doi:10.1177/2040620713490316George L, Peter D, Chopra M, et al.Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience.Bone Marrow Transplant.2016;51:988-90. doi:10.1038/bmt.2016.13Feldreich N, Ringden O, Emtestam L, Omazic B.Photochemotherapy of cutaneous graft-versus-host disease may reduce concomitant visceral disease.Dermatology(Basel). 2016;232(4):453-63. doi:10.1159/000447058Gutierrez CA, Raval MV, Vester HR, Chaudhury S, Von Allmen D, Rothstein DH.Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature.J Pediatr Surg. 2017;52(11):1718-1722. doi:10.1016/j.jpedsurg.2017.06.022Montenegro D.Management of ocular GvHD. In: EyeWiki (American Academy of Ophthalmology).Van Dam N, Zelker R, Radiano R, Kadmon I, Bogorochin B, Frank-Kamenetsky Y.Vulvar and vaginal graft versus host disease: A healthcare clinic initiative.Asia Pac J Oncol Nurs.2017;4(2):116-9. doi:10.4103/apjon.apjon_6_17
Justiz Valliant AA, Modi P, Mohammadi O.Graft versus host disease. StatPearls.
National Health Service (UK).Guidelines for diagnosis and management of cutaneous graft-versus-host disease.
Koç N, Gündüz M, Azık MF, et al.Stepwise diet management in pediatric gastrointestinal graft versus host disease.Turk J Pediatr. 2016;58(2):145-51. doi:10.24953/turkjped.2016.02.004
Treister N, Duncan C, Cutler C, Lehmann L.How we treat oral chronic graft-versus-host disease.Blood.2012;120(17):3407-18. doi:10.1182/blood-2012-05-393389
Hashimoto K, Nagao T, Koie S, Miyabe S, Saito T.Secondary squamous cell carcinoma of the tongue complicated with bronchiolitis obliterans as a manifestation of graft-versus-host disease following peripheral blood stem cell transplantation.Case Rep Hematol.2019;2019:6015803. doi:10.1155/2019/6015803
Sanz-Narco E, Udaondo P, García-Delpech S, Vazquez A, Diaz-Ilopis M.Treatment of refractory dry eye associated with graft versus host disease with 0.03% tacrolimus eyedrops.J Ocul Pharmacol Ther.2013;29(8):776-83. doi:10.1089/jop.2012.0265
Roddy JV, Haverkos BM, Mcbride A, et al.Tocilizumab for steroid refractory acute graft-versus-host disease.Leuk Lymphoma. 2016;57(1):81-5. doi:10.3109/10428194.2015.1045896
Meier JK, Wolff D, Pavletic S, et al.Oral chronic graft-versus-host disease: Report from the International Consensus Conference on clinical practice in cGVHD.Clin Oral Invest.2011;15:127-39. doi:10.1007/s00784-010-0450-6
Kim YJ, Lee GH, Kwong BY, Martires KJ.Evidence-based, skin-directed treatments for cutaneous chronic graft-versus-host disease.Cureus.2019;11(12):e6462. doi:10.7759/cureus.6462
Arora M, Klein JP, Weisdorf DJ, et al.Chronic GVHD risk score: A Center for International Blood and Marrow Transplant Research analysis.Blood. 2011;117(24):6714-20. doi:10.1182/blood-2010-12-323824
Garnett C, Apperley JF, Pavlů J.Treatment and management of graft-versus-host disease: improving response and survival.Ther Adv Hematol. 2013;4(6):366-78. doi:10.1177/2040620713489842
Ram R, Storb R.Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future.Leuk Lymphoma.2013;54(8):1591-601. doi:10.3109/10428194.2012.762978
Hart JW, Shiue LH, Shpall EJ, Alousi AM.Extracorporeal photopheresis in the treatment of graft-versus-host disease: Evidence and opinion.Ther Adv Hematol. 2013;4(5):320-34. doi:10.1177/2040620713490316
George L, Peter D, Chopra M, et al.Efficacy of narrow band UVB in the treatment of cutaneous GvHD: an Indian experience.Bone Marrow Transplant.2016;51:988-90. doi:10.1038/bmt.2016.13
Feldreich N, Ringden O, Emtestam L, Omazic B.Photochemotherapy of cutaneous graft-versus-host disease may reduce concomitant visceral disease.Dermatology(Basel). 2016;232(4):453-63. doi:10.1159/000447058
Gutierrez CA, Raval MV, Vester HR, Chaudhury S, Von Allmen D, Rothstein DH.Surgical treatment of intestinal complications of graft versus host disease in the pediatric population: Case series and review of literature.J Pediatr Surg. 2017;52(11):1718-1722. doi:10.1016/j.jpedsurg.2017.06.022
Montenegro D.Management of ocular GvHD. In: EyeWiki (American Academy of Ophthalmology).
Van Dam N, Zelker R, Radiano R, Kadmon I, Bogorochin B, Frank-Kamenetsky Y.Vulvar and vaginal graft versus host disease: A healthcare clinic initiative.Asia Pac J Oncol Nurs.2017;4(2):116-9. doi:10.4103/apjon.apjon_6_17
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What Is Graft-Versus-Host Disease?Causes and Risk Factors of Graft-Versus-Host DiseaseHow Graft-Versus-Host Disease (GvHD) Is DiagnosedHow Graft-Versus-Host Disease (GvHD) Is TreatedCoping With Graft-Versus-Host-Disease
Causes and Risk Factors of Graft-Versus-Host Disease
How Graft-Versus-Host Disease (GvHD) Is Diagnosed
How Graft-Versus-Host Disease (GvHD) Is Treated
Coping With Graft-Versus-Host-Disease
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