Types and grades of GvHD

Types of GvHD

There are 2 main types of GvHD. They are:

• acute GvHD
• chronic GvHD

But sometimes the 2 conditions can overlap. GvHD may affect different areas of your body. The most common areas it affects are the:

• skin
• gut (including the bowel and stomach) 
• liver

But it can affect other parts of the body. 

Acute GvHD

Acute GvHD generally starts within 100 days of your transplant but it can sometimes happen after this time. It usually happens about 2 to 3 weeks after your transplant when your new bone marrow  begins to make blood cells. This is called engraftment.

It can be mild, moderate or severe. It often starts with a rash on:

• the palms of your hands
• the soles of your feet
• your ears
• your face

The rash may be itchy or painful. GvHD may also affect your mouth, gut (digestive system) and liver. This can cause:

• diarrhoea 
• sickness
• loss of appetite and weight loss 
• tummy (stomach) cramps
• yellowing of the skin (jaundice)

Chronic GvHD

Chronic GvHD starts more than 100 days after your transplant. You are more likely to get it if you have had acute GvHD but it can happen even if you haven't. It can be mild to severe, and for some people can go on for several months or even years.
It may affect your:

• skin
• gut
• liver 
• mouth
• eyes
• lungs
• genitals such as the penis, vulva or vagina
• joints

Late acute GvHD and overlap syndrome

There are two other types of GvHD known as:

• late acute GvHD which starts after day 100
• overlap syndrome with features of both acute and chronic GvHD

They are both more likely to happen after mini transplants (reduced intensity conditioning). Nowadays, doctors use mini transplants more often.

Grading acute GvHD

Your doctor assesses your GvHD and gives it a grade. There are 4 grades which range from grade 1 to grade 4. 

The grade depends on:

• the number of organs affected (skin, bowel, or liver) - GvHD can affect any or all of these 3 organs
• how bad the GvHD is

Your treatment depends on the grade of your GvHD. You might not need any treatment if you have grade 1 GvHD, but you will need some type of treatment for grade 2 or above.
 
Grade 1 is mild GvHD. It means up to a quarter (25%) of your skin is affected.

Grade 2 is moderate GvHD. It means up to half your skin (25 to 50%) is affected. There are mild changes in your liver or you may have some mild diarrhoea or feel sick.
 
Grade 3 is severe GvHD. It means more than half your skin (over 50%) is affected. You may look as though you have severe sunburn. Your liver is affected and you have stomach cramps and diarrhoea.

Grade 4 is very severe GvHD. Your skin has blistered and may have broken down in places. Your skin may be yellow (jaundiced) because your liver is not working properly. You have severe diarrhoea.
 

Grading chronic GvHD

Your doctor assesses your GvHD. They look at the number of organs involved and how severe it is. Depending on this they give it one of the following grades:  

• mild
• moderate
• severe