Bone Marrow Transplant Acute Graft vs. Host Disease

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After someone has a bone marrow transplant (BMT), the donated bone marrow or stem cells (graft) can attack healthy tissue in a patient’s (host’s) body. This is called graft-versus-host disease (GVHD). When this happens, a patient’s organs and tissues may not work like they’re supposed to.

  • There are two types of GVHD – acute (aGVHD) and chronic (cGVHD).
  • Acute GVHD usually happens during the first 100 days after a BMT, but it could happen after that.
  • aGVHD is more common in patients that have an allogeneic BMT. Allogeneic means the donated graft was from someone other than the patient.

Signs and Symptoms

  • Nausea
  • Throwing up (vomiting)
  • Not much appetite
  • Stomach cramps
  • Watery diarrhea
  • Red skin rash anywhere on the body
  • Yellowing of the skin and eyes

Diagnosis and Staging

Acute (aGVHD) may be mild, moderate, severe, or life-threatening. It is broken down into stages. Each stage depends on what symptoms your child has. A procedure, called a biopsy, may be done to remove a small piece of tissue from the skin, intestines, or liver. This will confirm the diagnosis.

Stages of aGVHD

  • Stage 1 (Mild)
    • Skin rash over less than 25% of the body
  • Stage 2 (Moderate)
    • Skin rash over more than 25% of the body
    • Mild liver, stomach, and intestinal problems
  • Stage 3 (Severe)
    • Skin looks red like a severe sunburn
    • Moderate liver, stomach, and intestinal problems
  • Stage 4 (Life-threatening)
    • Blisters
    • Peeling skin
    • Severe liver, stomach, and intestinal problems


Your child’s health care provider will talk to you about the best treatment option(s) for them.

  • aGVHD is usually treated with drugs that weaken the immune system. Having a weak immune system means it’s easier to get sick. You and your child will need to take steps to prevent infection.
  • Treatment could last several months.
  • Your child may be prescribed a cream to put on their skin. The cream will help with their skin rash.
  • Keep your child protected from the sun. Apply sunscreen with a sun protection factor (SPF) of 30 or more any time they’re outside.

If you have any questions or are concerned that your child has signs or symptoms of aGVHD, please ask your child’s BMT health care provider.

Bone Marrow Transplant: Acute Graft versus Host Disease (PDF)

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