Cancer: Graft Versus Host Disease

Stem cell transplants are a common treatment for patients with cancer that affect blood cells. Allogeneic stem cells are transplanted from another individual that isn’t the patient or their identical twin. This treatment provides patients with healthy, blood forming stem cells. This treatment is often recommended to patients after receiving high dose chemotherapy or radiation. Some patients develop a complication, Graft Versus Host Disease, after receiving a stem cell transplant.

Symptoms

Patients with Graft Versus Host Disease can experience:

Rash
Diarrhea
Vomiting
Abdominal cramping
Jaundice

Hair loss
Gum disease
Fatigue
Muscle weakness

Causes

Graft versus host disease (GvHD) is caused by an immune response to an allogeneic stem cell transplant, a common treatment for cancer. The gastrointestinal tract is a common site affected by acute GvHD. Other sites include the skin and liver. Typically, white blood cells help protect the body from bacteria and viruses. They can also identify the human leukocyte antigens (HLA) present on your body’s cells. This keeps them from attacking your own cells. Stem cells received from another person will have a different HLA, sometimes unrecognizable, which can cause an immune response. Healthcare providers who conduct these treatments test a potential donor’s HLA carefully to try and determine the best match for the patient. Although the donation and matching process is intense, there is always a risk of developing graft versus host disease unless receiving stem cell donation from an identical twin.

Treatment

Prior to stem cell transplantation, patients will receive immunosuppressant medication to help decrease your immune system’s chance of an immune response. These medications may not completely prevent the development of graft versus host disease. Once a patient develops GvHD their physician will prescribe medication and treat the illness depending on the severity of the case.

Microbiota Therapy Research

ACT research partners at the University of Minnesota and Fred Hutchison Cancer Center are investigating the impact of Microbiota Transplant Therapy in preventing Graft Versus Host Disease.

Fecal Microbiota Transplantation for the Prevention of Acute Graft Versus Host Disease in Adults Undergoing Allogeneic Hematopoietic Cell Transplantation
Trial Location: Fred Hutchinson Cancer Center – Seattle, WA
Trial Status: Underway
Trial Summary:
Researchers at the Fred Hutchinson Cancer Center are investigating whether fecal microbiota transplant can prevent severe acute graft versus host disease in adults undergoing allogeneic hematopoietic cell transplantation.
For more information, visit: https://clinicaltrials.gov/study/NCT06026371
Fecal Microbiota Transplant and Dietary Fiber Supplementation for the Treatment of Gut Graft Versus Host Disease
Trial Location: Fred Hutchinson Cancer Center – Seattle, WA
Trial Status: Underway
Trial Summary:
Researchers in Washington are investigating whether treatment with Microbiota Transplant Therapy and fiber supplementation improves patient outcomes with mild to severe acute Graft Versus Host Disease.
For more information, visit: https://clinicaltrials.gov/study/NCT05067595
Pretransplant Serum Citrulline Predicts Acute Graft-versus-Host Disease
Trial Location: University of Minnesota – Minneapolis, MN
Trial Status: Completed
Trial Summary:
Researchers studied biomarkers of patients prior to Hematopoietic Cell Transplantation (HCT). Compared to 16 healthy control patients, “pre-transplant patients came to transplant with abnormal levels of all three biomarkers, reflecting residual damage from prior chemotherapy.” The study suggests that pre-HCT interventions to the gut microbiome may decrease patient risk for Graft-Versus-Host disease post HCT.
To read the study publication, visit: https://pubmed.ncbi.nlm.nih.gov/30454871/
Infection followed by Graft-versus-Host Disease: Pathogenic Role of Antibiotics
Trial Location: University of Minnesota – Minneapolis, MN
Trial Status: Completed
Trial Summary:
This phase 1 placebo-controlled trial demonstrated microbiota transplants are safe within this immunocompromised patient population. A follow up trial is underway to optimize dosing.
To read the study publication, visit: https://www.astctjournal.org/article/S1083-8791(17)30304-X/pdf