Happy Easter everyone! It’s another lovely sunny day in Stanford. Since we’ve been here, day after day has been beautiful and cloudless, one of the things that people love so much about California … unless, that is, you cannot be out in the sun. Deb is now extremely sensitive to the sun, which can trigger Graft vs Host Disease (GVHD), a common complication of an allogeneic transplant. GVHD develops when the donor’s immune cells regard the recipient (the host) as “foreign.” The transplanted immune cells then attack the host’s body cells. This often manifests as skin rashes and blisters, gastrointestinal problems, and jaundice.
The doctors encourage Deb to take walks, and we usually go out late in the day and walk for about 20 minutes. On Wednesday we thought we’d try to take a couple of walks, and went out for our first walk in the late morning. Deb was covered from head to toe with a hat, scarf, gloves, jacket and long pants. She had on her big HEPA filter mask, so there was only a small part of her face that was exposed. We mostly stayed in the shade, but there were some areas on the path that were in the sun. That afternoon, Deb’s face started getting red, itchy and swollen. She also got a rash on her neck, chest and back. We went to the Cancer Clinic the next morning, and they said it was GVHD. They told us it doesn’t take much sun to trigger GVHD, and once it starts, it can spread to areas that were not exposed to the sun. This was quite a wake-up call for us; we knew Deb couldn’t spend much time in the sun, but we didn’t realize just how sensitive she is to it. Deb was prescribed some steroid creams to use, and they have helped to improve the rash, but it is not all cleared up yet. It’s been uncomfortable and itchy, and an unexpected blip when things seemed to be going so well.
The positive aspect to this is that they say a little GVHD can be good. Here is a quote from the Be The Match website: “Doctors often see mild GVHD as a good thing after an allogeneic transplant when the transplant was done for a blood cancer. It is a sign that the donor’s immune system is working to destroy any remaining cancer cells. Patients who experience some GVHD have a lower risk of the cancer returning after transplant than patients who do not develop GVHD.” So we’ll try to look at this as a positive learning experience, but we’ll be taking all of our walks in the evening from now on!