A 50-Year-Old-Woman With cGVHD
Panelists discuss how patient education and multidisciplinary involvement are critical for early detection of chronic graft-vs-host disease (cGVHD).
Clinical Case Presentation (Part 1)
A 50-year-old woman underwent allogeneic transplant with reduced-intensity conditioning from a matched unrelated donor for mesenchymal stromal cells. Her donor was a cytomegalovirus-negative 45-year-old man, and GVHD prophylaxis was tacrolimus and mycophenolate mofetil.
At 7 months post transplant, she presented with:
- Lichen planus–like eruptions on back and upper chest
- Sclerotic features on lower trunk and thighs (22% body surface area)
- Oral and ocular dryness
- Mild joint stiffness in hands/wrists
- Mild dyspnea and fatigue
- Pulmonary function tests showing mild decline in DLCO with stable FEV1
The panel agreed this represents:
- Clear evidence of chronic GVHD with multiple organ involvement
- Moderate to severe cGVHD by National Institutes of Health (NIH) criteria
- Need for systemic immunosuppressive therapy
- Importance of thorough pulmonary evaluation, potentially including CT scan
All panelists use the NIH scoring system in their practices, with organ-specific assessments at each visit.
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