Introduction to Graft-versus-Host Disease (GVHD)

This is a recording of a workshop presented at the 2023 Survivorship Symposium.
Summary: Graft-versus-host-disease (GVHD) is a common challenge for patients who undergo a stem cell transplant using cells from a donor (an allogeneic transplant). It can be mild, moderate or severe. This presentation reviews the types of GVHD, the organs most often affected, common symptoms, and traditional as well as newer therapies for treating GVHD.
Presenter: Andrew Harris MD, Memorial Sloan Kettering Cancer Center
To read the transcript, go to:
www.bmtinfonet.org/video/intr...
Highlights:
- GVHD occurs when transplanted cells from a bone marrow or stem cell donor attack the patient’s body. Acute GVHD typically occurs soon after transplant; chronic GVHD typically occur much later, although both can occur at any time. They can also occur simultaneously which is referred to as overlap syndrome or overlap GVHD.
- Almost half of adults transplanted with stem cells or bone marrow from a donor will experience some form of acute GVHD within a few months of treatment. Chronic GVHD occurs in 15% to 40% of patients.
- There are many therapies for GVHD that can be used in different combinations to prevent or minimize graft-versus-host disease. The type of transplant a patient is receiving and any comorbidities will also be considered to personalize their medication regimen to treat GVHD.
April 2023, Part of the Virtual Celebrating a Second Chance at Life Survivorship Symposium
Presentation is 38 minutes long with 22 minutes of Q & A
Key Points:
(00:05:28): One method to prevent GVHD is to modify donor cells by removing cells that are most likely to cause GVHD before transplantation.
(00:07:42): Medications like cyclosporine and tacrolimus are also used to prevent GVHD. These medications must be closely monitored to produce the desired effect and minimize other risks.
(00:17:00): Acute GVHD typically affects the skin and can also affect the digestive tract and/or liver.
(00:20:30): Treatment for acute GVHD includes topical steroid creams or more systemic steroid therapy.
(00:22:26): Steroids can be effective in treating acute GVHD but have many unpleasant side effects, especially with prolonged use. If steroids are not effective in treating GVHD, other treatments like Jakafi® and photopheresis are now available and they can be fairly effective.
(00:27:16): Chronic graft-versus-host disease can involve almost any part of the body, or any combination of body sites, including the eyes, lungs, skin, mouth, digestive tract, genitals, muscles and joints.
(00:30:47): Localized treatments like creams, mouth washes, artificial tears or antibiotics with anti-inflammatory propertiers are preferable treatments for if chronic GVHD is not affecting many different organs simultaneously.
(00:33:18): Systemic therapies like steroids are also used to treat chronic GVHD. It may also be treated with Imbruvica®, Jakafi®, or Rezurock®.
(00:36:15): Treatment for chronic GVHD can bring physical challenges like muscle weakness, weight gain, and limited mobility.
(00:36:58): Steroid treatment for chronic GVHD can bring many emotional challenges and affect a patient’s quality of life, participation in school or work, and sexual health on top of the direct effects pf GVHD itself.
Meet the speaker:
www.mskcc.org/cancer-care/doc...
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[@44court]

for an older patient is the transplant really worth all the complications from GVHD