Inside the Clinic: Acute Graft-versus-Host Disease - Episode 1

Graft-Vs-Host Disease Explored

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Yi-Bin A. Chen, MD: Welcome to OncLive Insights® Inside the Clinic. Today we will be discussing acute graft-vs-host disease. My name is Dr Yi-Bin Chen. I am the director of the Blood and Marrow Transplant Program at Massachusetts General Hospital in Boston, Massachusetts. Joining me today are my colleagues Colleen Danielson, 1 of our nurse practitioners, and Dr Zach DeFilipp, another physician in our program.

We’re excited to be here to talk about acute graft-vs-host disease because we feel it’s very relevant to what we do each and every day. It remains an unmet need in our patient population and with the treatment that we provide. There have been recent advances, which we’re excited to share, and we look forward to the future as we continue to improve what we do.

I think the first issue is to talk about what acute graft-vs-host disease is and how it’s defined. Acute graft-vs-host disease is a complication of allogeneic hematopoietic stem cell transplantation. We use stem cell transplantation to treat a variety of mostly hematological malignancies with intent for curative purpose. The therapeutic effect of allogeneic transplantation theoretically lies in the ability of the donor’s white blood cells to be able to exert an immunological anticancer effect on the host’s malignancy. The tax to that, or the complication to that, is the donor and the host are not identical. They often match very closely immunologically, but they’re not identical twins. And the donor cells, if they grow up, can often attack not only the patient’s underlying malignancy but also the healthy body. That is acute graft-vs-host disease. That is the complication we deal with.

On a time frame in which graft-vs-host disease is divided into acute and chronic, we’re going to spend most of our time today talking about acute graft-vs-host disease, which most commonly takes place within the first 6 months after transplantation. In the past, historically, it was defined as happening within the first 100 days of transplant. However, with changes in practice, in graft sources, in the chemotherapy regimens that we use, in the mechanisms of preventing graft-vs-host disease, and all the differences in practice, that time frame no longer applies. Acute graft-vs-host disease is defined solely by the symptoms. It affects 3 organs—the skin, the liver, and the GI [gastrointestinal] tract. The skin most commonly, and the GI tract second most commonly; the liver is the rarest manifestation we see.

It is true that in the last 2 decades we have seen a significant decrease in not only the incidence but also the severity of graft-vs-host disease. A lot of that is because of advances in other medicine. When I say that, I mean supportive care and other fields of medicine that transplant has benefited from. But probably the most important development has been improvements in how we type donors and recipients. With much more exact HLA [human leukocyte antigen] typing, we’ve been able to match donors at a much more precise level. That has reduced the severity of acute graft-vs-host disease.

Transcript Edited for Clarity