7 Early Symptoms of Chronic Graft Versus Host Disease You Don’t Want to Miss

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Chronic graft-versus-host disease (GvHD) affects nearly half of people who've received a bone marrow or stem cell transplant. The condition can last a lifetime.

Treatment can ease symptoms, stop organ damage and improve quality of life. Treatment works best when it's started early. But spotting early symptoms of chronic GvHD isn't always easy. The early signs can be subtle and easy to miss. Staying alert for these early symptoms can be lifesaving. Here are seven common early symptoms of chronic GvHD.

1. Dry eyes

Dry eye is a common symptom of chronic GvHD. Dry eye develops because donor immune cells attack eye glands that make oils and tears. Dry eye can be irritating, painful, and affect your vision. Dry eye symptoms include:

• Eye redness

• Blurry vision

• Gritty sensation in the eyes

• Burning sensation in the eyes

• Watery eyes

Talk with your healthcare team if you notice any of these eye symptoms, even if they seem minor.

2. Dry mouth

Dry mouth develops when donor immune cells attack the salivary glands, which make saliva. You may also notice symptoms like:

• Trouble swallowing food

• Pain when eating

• Mouth pain

• Sensitivity to hot, cold, or spicy foods

• Taste changes

• Redness of the mouth or tongue

• Soreness of the mouth or tongue

• Mouth ulcers

• White patches on the tongue

Over time, dry mouth can lead to infections and dental decay. Chronic GvHD can also lead to mouth scarring, which can make it hard to completely open your mouth.

3. Rashes

Chronic GvHD can also affect your skin. Skin symptoms may be mild at first and include:

• Redness

• Dryness

• Itchiness

You may also experience more noticeable symptoms like:

• Skin color changes

• Texture changes like skin thinning or roughening

• Blisters or skin sores

• Scaly patches

• Skin tightening

Chronic GvHD can also lead to a skin condition called sclerosis. Sclerosis causes tightness and hardening of the skin and the tissues underneath the skin. This can lead to trouble moving your arms and legs.

4. Hair and nail changes

Hair and nail changes are a common symptom of chronic GvHD. You may notice symptoms like:

• Hair thinning

• Hair loss or bald patches

• Loss of body hair

• Eyebrow and eyelash thinning or loss

• Premature graying

• Itchy scalp

• Brittle nails

• Split nails

• Nail loss

These changes develop because donor cells attack cells that create hair and nails. These cells are similar to skin cells. You may notice skin symptoms along with hair and nail changes. But it's also possible to experience one without the other.

5. Gut problems

Donor cells can attack the lining of the gastrointestinal system. This can lead to a wide array of gut-related symptoms including:

• Loss of appetite

• Unexpected weight loss

• Nausea

• Vomiting

• Stomach pain

• Diarrhea

• Indigestion

• Gas and bloating

You may experience some of all of these symptoms. Some of these symptoms may be more obvious or constant than others.

6. Trouble breathing

Chronic GvHD can also affect the lungs and the lining of the respiratory system. This can lead to symptoms like:

• Cough that doesn't go away

• Shortness of breath

• Lowered exercise tolerance (feeling less able to exercise)

• Chest tightness

• Trouble taking deep breaths

• Wheezing

Chronic GvHD also increases the risk of developing serious lung infections like pneumonia. Some people don't develop symptoms even though they have inflammation in their lungs from chronic GvHD. Your healthcare team may ask you to complete pulmonary function tests on a regular basis. Pulmonary function tests offer information about your lung health and can reveal early signs of chronic GvHD.

7. Joint and muscle pain

Many people experience joint and muscle symptoms from chronic GvHD. Signs that donor cells are attacking joints and muscles include:

• Joint pain or stiffness

• Muscle tenderness

• Muscle weakness

• Muscle cramps

• Trouble fully moving a joint

• Joint or muscle tightness

You may notice these symptoms in any of your muscles and joints, including small joints in your fingers, hands, and feet. It's possible to experience these symptoms in only a few areas of your body.

When to get care for chronic GvHD symptoms

Reach out to your transplant team about symptoms right away. The sooner you identify your symptoms, the sooner you can get a diagnosis of chronic GvHD and start treatment. Treatment options can lower inflammation and prevent further damage. Treatment can also ease your symptoms and make you more comfortable.

Your transplant team can also help you find a care team that's specialized in GvHD. These teams understand how to diagnose and treat GvHD and can help you find the best treatment options. They can also help you enroll in clinical trials, which offer an opportunity to access new treatment options before they are widely available.

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