A 50-Year-Old-Woman With 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.