Have you ever wondered how chronic graft-versus-host disease (GVHD) affects life after a stem cell transplant? While studies show that having a stem cell transplant can shorten the lifespan by an average of 30 percent, developing GVHD can further increase the risk. One study found that while people who have had a stem cell transplant might be expected to live an average of 21 years less, for people who also had chronic GVHD, the reduction in life expectancy rose to an average of 35 years. But there are promising new treatments available. People with GVHD are now living longer than ever.

In this article, we’ll discuss how chronic GVHD affects your life expectancy after a stem cell transplant. We’ll also cover how new treatments help people with this disease live longer, healthier lives. If you have other questions about life expectancy and outcomes after a transplant, talk to your doctor or transplant team.

What Is Chronic GVHD?

Chronic GVHD affects people who have had an allogeneic hematopoietic stem cell transplant. Also known as a bone marrow transplant or BMT, this procedure involves receiving healthy stem cells from a donor. The cells replace your diseased bone marrow to treat blood diseases like acute myeloid leukemia and lymphoma.

Your transplant team will try to match the donor cells as closely as they can to your cells. Specifically, they look at the human leukocyte antigen (HLA) markers on your cells. It’s important that the donor cells’ HLA markers match yours as much as possible. This is because the donor cells may mistake your own cells for foreign invaders. They can attack and damage your tissues, leading to chronic GVHD.

Chronic GVHD usually appears more than 100 days after a stem cell transplant, with clear signs and symptoms of the disease. Acute GVHD is usually diagnosed earlier, with symptoms affecting multiple organs — like the skin, liver, and gastrointestinal tract. According to the Leukemia & Lymphoma Society, chronic GVHD can last several years. In some people, symptoms can last for the rest of their lives.

Chronic GVHD Can Affect Your Survival After a Transplant

Studies show that nearly 80 percent of people who have had an allogeneic stem cell transplant are alive after 10 years. The highest risk of dying occurs within the first few years after a transplant. Severe forms of acute GVHD, infections, and disease relapse are usually responsible for these early deaths. If you survive the first few years after the transplant, your health outlook improves. However, chronic GVHD is one of the most common causes of transplant-related deaths that happen several years after the transplant itself.

Chronic GVHD Raises the Risk of Nonrelapse Mortality

When talking about survival after a transplant, doctors use the term “nonrelapse mortality.” This refers to the chances that a person would die because of transplant-related complications that have nothing to do with their cancer returning. Stem cell transplants generally lower the risk of your cancer returning and improve your health outlook. However, there’s a chance that chronic GVHD or another complication can lead to death.

One study looked at a group of 937 transplant recipients. The authors found that the risk of nonrelapse mortality after an allogeneic stem cell transplant was 22 percent after five years. Researchers projected the risk of nonrelapse mortality would increase to 40 percent after 12 years. Overall, chronic GVHD was the most common cause of nonrelapse mortality after a transplant. The study showed it accounted for around 37 percent of deaths. People who developed chronic GVHD were also more likely to deal with infections and organ failure.

Chronic GVHD Can Lower Your Life Expectancy

Research shows that receiving an allogeneic stem cell transplant can significantly lower life expectancy. Compared to the general population, the population of people who’ve had a stem cell transplant experiences a 30 percent drop in life expectancy.

Chronic GVHD contributes to mortality risk for transplant recipients. In a study of over 2,500 people post-transplant, the life expectancy of those who had chronic GVHD was an average of 35 years less. Those in the study who didn’t have chronic GVHD lived an average of 21 years less than the general population.

Which Factors Affect Life Expectancy With Chronic GVHD?

Research shows that some risk factors affect life expectancy while living with chronic GVHD. Unfortunately, many of these factors are out of your control. However, taking extra steps to control your symptoms with the right treatments can help improve your outlook.

Symptom Severity

The more severe your symptoms are, the worse your outlook may be. City of Hope Cancer Center explains that people with body-wide symptoms of GVHD tend to have lower survival rates. Examples of these include:

• Diarrhea
• Lung problems, like trouble breathing
• Liver function issues, which lead to high enzyme levels
• Symptoms affecting the majority of your skin, including rashes and sores

Chronic GVHD is graded based on how severe your symptoms are. Overall, the higher your grade is, the lower your five-year survival rate.

Older Age

If you had your stem cell transplant at an older age, you have a higher risk for other health complications — including chronic GVHD. One report studied over 4,440 adults older than 40 who’d had an allogeneic stem cell transplant. The authors noted that adults 60 years and older with moderate or severe chronic GVHD had a higher risk of nonrelapse mortality. However, the older adults also had a worse overall survival rate after their transplant, whether they had chronic GVHD or not.

Infections

Chronic GVHD makes it harder for your body to fight infections. People with chronic GVHD are more likely to develop bacterial infections, which are associated with a higher risk of death.

New Treatments Help People With Chronic GVHD Live Longer

Doctors and researchers are always looking for new treatments. New chronic GVHD treatments now help people live longer, healthier lives.

Traditional treatments for chronic GVHD focus on calming the immune system to control inflammation. Immunosuppressive medications and corticosteroids work well for some people but not others. The U.S. Food and Drug Administration (FDA) has approved new therapies for chronic GVHD. Examples include:

• Belumosudil (Rezurock)
• Ruxolitinib (Jakafi)
• Ibrutinib (Imbruvica)

These medications block specific parts of the immune system to stop donor cells from attacking your body.

Healthcare professionals also encourage people with chronic GVHD to join clinical trials. A clinical trial is a large study investigating a new treatment. All medications need to go through these studies before they get FDA approval. Talk to your doctor if you’re interested in joining a clinical trial.

Hope for Those Living With Chronic GVHD

Recent studies show that people with chronic GVHD continue living longer lives thanks to new treatments. The first step to addressing your disease is to keep an eye out for new symptoms. If you start noticing any changes in your health, be sure to talk to your doctor or transplant team. They’ll make a final diagnosis and create a treatment plan to control your GVHD. Staying on top of your symptoms is key.

Talk With Others Who Understand

On myGVHDteam, the site for people with graft-versus-host disease and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Do you or a loved one have life-threatening complications related to GVHD? What type of follow-up care are you receiving? Share your experience in the comments below.