A GVHD Clinical Scenario

Opinion
Video

Drs Yi-Bin Chen, Corey Cutler, Hannah Choe, and Mitchell Horwitz review a clinical scenario of chronic GVHD post-allogeneic transplant. They explore treatment options and emphasize shared decision-making, considering patient preferences and therapeutic benefits.

This is a video synopsis of a discussion involving Dr Yi-Bin Chen, Director of the Transplant and Cell Therapy Program at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School; Dr Corey Cutler, Director of the Stem Cell Transplant Program at Dana-Farber Cancer Institute and Professor of Medicine at Harvard Medical School; Dr Mitchell Horwitz, Professor of Medicine and Director of the Adult Blood and Marrow Transplant Program at Duke University, and Dr Hannah Choe, Assistant Professor and Director of the Graft-versus-Host-Disease (GVHD) program at Ohio State University.

The panelists discuss a clinical scenario involving a patient 4 to 5 months post-allogeneic transplant for AML [acute myeloid leukemia] presenting with a new skin rash covering 75% of the body surface area and dry eyes. Considering the multi-organ involvement and body surface area, the presentation is deemed consistent with chronic GVHD, warranting systemic therapy.

Dr Yi-Bin Chen details the case, describing the addition of prednisone at a dose of half a milligram per kilogram per day, coupled with a tapering dose of a calcineurin inhibitor. After two weeks with no improvement, the panelists agree that second-line therapy is necessary, with a consensus on using ruxolitinib. The discussion delves into alternative options beyond ruxolitinib and ibrutinib, considering factors such as the patient's tolerance, safety profile, and the availability of clinical trials.

Dr Corey Cutler suggests revisiting therapeutic dosing of the calcineurin inhibitor or exploring sirolimus as an adjunct to corticosteroids due to its regulatory T-cell sparing effect. Clinical trials are also recommended as a viable alternative to ruxolitinib, considering its efficacy in second and third-line therapies. Dr Hannah Choe introduces Extracorporeal Photopheresis (ECP) as a potential option, particularly for skin-related chronic GVHD, emphasizing its therapeutic benefits.

The discussion touches on shared decision-making, highlighting the importance of considering patient preferences, convenience, and ease of access in selecting the appropriate second-line therapy for chronic GVHD.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.

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