Treatment
The treatment of GVHD is challenging since it is a natural consequence, and not technically a side effect. The key to successful treatment, then, is to prevent rather than treat the established condition. Treatment of both acute and chronic GVHD is medical in the most part with a minor surgical role in the interventions needed to deliver some medical treatments such as a central venous catheter.
A) Treatment of acute GVHD:
The treatment of acute GVHD is centered around preventing it by using a standard regimen of chemotherapy such as methotrexate, cyclosporine and tacrolimus. These are usually the main drugs administered in all cases, especially those with unrelated donors because of the higher risk of GVHD. Other non-chemotherapy options that are usually used adjunctly with chemo include plasmapheresis, where lymphocytes -the cells which have the greatest role in GVHD- are killed by external agents, or through ATG which are antibodies directed towards them.
If acute GVHD is established with symptoms, treatment depends on the severity and the number of organs involved. Doctors have a system of classifying the severity of the disease using roman numerals I, II, III, iv etc. and they employ treatment regimens in a stepwise approach.
• Regarding skin manifestations of acute GVHD, the first option in mild disease is local steroids. Corticosteroids remain the most effective non chemotherapy immunosuppressive. If the disease is progressive, the addition of steroids whether orally or by injection plus the original immunosuppressive chemotherapy used as a prophylaxis is the mainstay of treatment.
• The use of anti-thymocyte globulin or targeted therapies is also advocated in some conditions. Stem cell therapy has undergone excessive clinical trials and is showing promise.
• If the above treatment is ineffective, higher doses of steroids, monoclonal antibody therapy including infliximab as well as targeted therapy like etanercept are used. Another approach can be taken by administering high doses of chemotherapy like mycophenolate mofetil, one of the most potent immunosuppressive drugs. Ultraviolet irradiation is also beneficial for skin manifestations.