What is GVHD of the lungs (pulmonary GVHD)?

Chronic graft-versus-host disease (GVHD) of the lungs happens when donated cells a patient receives during a blood or marrow transplant (BMT) begin attacking the small airways in the lungs. This can make your lungs inflamed, cause scarring and eventually lead to your lungs not working properly.

Lung GVHD can make breathing more difficult. Some people notice symptoms right away, while others may not have symptoms until the disease has progressed. Early testing is important because lung GVHD can be present even before symptoms appear.

• Shortness of breath
• A cough that does not go away
• Chest tightness or pressure
• Feeling like you can’t take a deep breath
• Less ability to exercise or be active

People with GVHD of the lungs are more likely to get lung infections. Infections can make GVHD worse, so it’s important to contact your doctor quickly if you notice new symptoms.

To learn more about how GVHD can affect different parts of your body, view our full list of GVHD symptoms.

Lung GVHD can be difficult to detect early because symptoms may be mild or not present at all. That is why regular testing is so important. Doctors may use:

• Pulmonary function tests (PFTs): Breathing tests that can find GVHD before symptoms begin. Your doctor may recommend these regularly after transplant, especially if you already have GVHD in another part of your body.
• CT scans: Imaging that shows changes in the lungs caused by inflammation or scarring.
• Bronchoscopy: A procedure using a thin tube to look inside the lungs and collect samples. This can help rule out infections that cause symptoms similar to GVHD.

Treatment works best when GVHD of the lungs is found and addressed early, before major symptoms develop.

Your doctor will create a plan based on your symptoms and test results. Options may include:

• Prescription immunosuppressants taken by mouth to reduce inflammation and slow scarring.
• Inhalers that deliver medicine directly into the lungs. It is important to use inhalers correctly so they work effectively.
• Asthma medicines or antibiotics, such as montelukast or azithromycin, to decrease inflammation or prevent infection.
• Extracorporeal photopheresis (ECP), a treatment where your blood is removed, treated with light and returned to your body.
• Pulmonary rehabilitation, a program that teaches breathing strategies and safe exercises to improve daily activity.
• Oxygen therapy or lung transplant for severe cases when breathing becomes very difficult.

• Wash your hands often to reduce infection risk.
• Avoid close contact with people who are sick.
• Get vaccines your doctor recommends, such as flu and pneumonia shots.
• Ask if it is safe to garden, mow the lawn or handle soil and plants, which can carry bacteria or fungi.
• Take your medicines exactly as prescribed.
• Stay as active as possible. Stronger muscles make breathing easier, but pace yourself.

• Your shortness of breath gets worse 
• You have a fever, or pain when you breathe 
• Your phlegm or mucus from your throat isn't clear (e.g., it's brownish or greenish) 
• Your cough gets worse or you're less able to take a deep breath

• Ask about regular pulmonary function tests (PFTs).
• Tell your care team about even small changes in your breathing.
• Consider pulmonary rehab if breathing problems limit daily activity.
• Ask if clinical trials may be an option for you.

NMDP^SM offers resources to help you navigate GVHD of the lungs and connect with people who understand your journey. Choose the support that’s right for you: