About GVHD

What is cGVHD?

 

hronic graft-versus-host disease (GVHD) is a common and potentially life-threatening complication which develops as a result of allogeneic hematopoietic stem cell transplantation (HCT),  when the transplanted cells react against the body of the recipient.  The prevalence varies from 25–80% in long-term survivors [1].


cGVHD can lead to serious physical and functional impairment that affects quality of life as it is often diagnosed late in its course, when disability has already begun [2].

What are the clinical manifestations for cGVHD?

cGVHD can effect basically any organs, with  the most commonly affected sites being: the skin, the mouth, the eyes, the gastrointestinal tract, the muscles and joints, the lungs, the liver, and genitalia. From a musculoskeletal point of view, the main concern for the Allied Health Professionals are [3,4,5,6]:

  • SKIN
  • FASCIA
  • PERIPHERAL NERVES
  • MUSCLE
  • BONE (Due to use of cortisone) 

Manifestations typically appear within the first year after HCT. The most commonly affected joints include fingers, wrists, elbows, shoulders, ankles, and hips, with the distal joints often affected first (anecdotal evidence). cGVHD is an independent risk factor for joint destruction and associated pain and dysfunction [7]  

What is the potential impact of musculoskeletal cGVHD on the Quality of Life (QoL) of the patients?

The number of long-term survivors after allogeneic bone marrow transplantation (BMT) has been increasing over the past years, and quality of life (QOL) has become an important end-point [8]. The QoL in these patient group can be affected due to:


Decreased range of motion, significantly restricting a patient’s ability to perform activities of daily living. 


Painful joint contractures in some patients resulting in impaired function. 


Chronic graft versus host disease  is an independent risk factor for joint destruction and associated pain and dysfunction [7].


Some patients also show deteriorated role functioning and global QOL, increased fatigue, and skin problems [9].


The long-term sexual complications include decreased libido, vaginal alterations, erectile and ejaculatory dysfunctions [10,11].


Due to physical dysfunction many patients also struggle to return to work post cGVHD [12], however your physical therapist along with the HSCT team, will be able to carry out a work-focused physical assessment and advice on return to work.