Chronic GVHD Incidence and Risk Factors

EP: 1.Clinical Scenario: A 38-Year-Old Man with Ph+ ALL

EP: 2.GVHD Incidence and Pathophysiology

EP: 3.Conditioning Regimens for Stem Cell Transplantation

EP: 4.Risk Factors for Acute and Chronic GVHD

EP: 5.The GVHD Prophylaxis Landscape

EP: 6.Acute GVHD Presentation and Diagnosis

EP: 7.Assessment and Grading of Acute GVHD

EP: 8.Frontline Steroid Treatment for Acute GVHD

EP: 9.Education and Resources for Patients with GVHD

EP: 10.Clinical Scenario: Chronic Graft Versus Host Disease

Now Viewing

EP: 11.Chronic GVHD Incidence and Risk Factors

EP: 12.Challenges with Early Diagnosis of GVHD

EP: 13.Frontline Treatment of Chronic GVHD

EP: 14.Steroid Administration for Chronic GVHD

EP: 15.The Steroid-Refractory Chronic GVHD Landscape

EP: 16.Selecting Therapy for Steroid-Refractory Chronic GVHD

EP: 17.Monitoring and Follow-Up of Patients with Chronic GVHD

Transcript:
Bonnie J. Dirr, APRN: What percentage of allo transplant patients are diagnosed with chronic graft-vs-host disease [GVHD]? I know you briefly discussed this earlier, but if you could highlight that for us at this moment for chronic graft-vs-host disease, that would be helpful.

Mahasweta Gooptu, MD: Sure. With tacrolimus and methotrexate, the registry numbers are in the 40% to 45% range for mild, moderate, or severe forms of chronic GVHD, while the severe forms themselves are about 10% of all of those who get chronic GVHD. This has changed quite dramatically with posttransplant cyclophosphamide; while the rates of grade 2 to 4 acute GVHD are not affected really by PT-Cy, the rates of severe acute GVHD are in the 6% to 8% range and the rates of severe chronic GVHD are in the 5% to 6% range, and the rates of moderate to severe chronic GVHD are much lower, maybe in the 20% to 25% range with fully matched donors, perhaps a little higher with haploidentical donors. A very significant change in chronic GVHD with the use of cyclophosphamide, and it mirrors the numbers if you use bone marrow product.

Bonnie J. Dirr, APRN: Thank you. When we think about, what is it that we are looking for with our patients when we are having them come in for their follow-up visits, it sounds like a very good history is also very important in terms of taking that information from our patients as well as looking at signs and symptoms for the chronic graft-vs-host disease. Because it can be subtle notations that the patients bring to us that often are the presenting factors that make us dive a little bit more into, say, a physical exam. Would that not be accurate?

Mahasweta Gooptu, MD: Oh, for sure. A good history is invaluable in diagnosing chronic GVHD, and a physical exam to corroborate your findings on history. It may not show up on any diagnostic test. A good clinical evaluation is necessary to make the diagnosis.

Bonnie J. Dirr, APRN: Yes. Thank you. What factors are shown to demonstrate higher risk for patients developing chronic graft-vs-host disease? In chronic graft-vs-host disease, what are the main challenges identifying patients early on? It’s a quite a bit of information there. Let’s break this down. What are some of the shown higher risks for patients in developing chronic graft-vs-host disease?

Mahasweta Gooptu, MD:Some of the factors would be the use of a mismatched donor, the use of [total body irradiation]…in the conditioning regimen, the use of older donors, the use of peripheral blood stem cells rather than bone marrow product. Of course, the GVHD prophylaxis regimen used greatly influences the rates of acute and chronic GVHD.

Bonnie J. Dirr, APRN: Thank you very much for bringing us back and highlighting some of those other factors for us.

Transcript is AI-generated and edited for clarity and readability.