Usama Gergis, MD

A 61-Year-Old Man With Graft-Versus-Host Disease

Steroid-Dependent Versus Steroid-Refractory Graft-Versus-Host Disease

Phase 2 REACH1 Overview

REACH1 Regimen: Steroid Combination and Adverse Events

Phase 3 Trials: REACH2 and GRAVITAS-301

The Future of GVHD Management

A 61-year old man presented with a generalized pruritic rash, abdominal pain and diarrhea (8-12 BMs/day)

PMH: he underwent haploidentical allogeneic hematopoietic-cell transplantation for AML 40 days ago

PE: maculopapular erythematous rash on bilateral palms, cheeks, ears and upper back (rash involvement >50% of skin); abdomen is tender to palpation diffusely



Labs: ANC 0.7 x 109/L, plt 75 x 109/L, total bilirubin 8 mg/dl, AST 54 U/L, ALT 60 U/L

Lower GI biopsy showed moderate mixed inflammation in the lamina propria and scattered apoptotic bodies without crypt loss

Skin punch biopsy of the back shows hyperkeratosis, hypergranulosis associated with lichenoid inflammatory infiltrate

Modified Glucksberg criteria: grade 3; MAGIC criteria: grade III



Systemic corticosteroids (prednisone 2 mg/kg/day) + topical steroids (triamcinolone)

He was started on ruxolitinib 5 mg PO BID, increased to 10 mg PO BID on day 6

Videos

Usama Gergis, MD, presents the case of a 61-year old man with GvHD, and provides an overview of available treatment options for similar patients, with consideration of the REACH1, REACH2, and GRAVITAS-301 trial regimens. 

Usama Gergis, MD | Authors

Articles

A 61-Year-Old Man With Acute Graft-Versus-Host Disease