The Current Field of Graft Versus Host Disease - Episode 7

Adverse Events From cGVHD Therapies

Adverse events related to chronic graft-vs-host-disease therapies and strategies to manage these adverse effects are considered.

Robert Zeiser, MD: They can induce diabetes, so we monitor the blood sugar in all patients, and we taper the corticosteroids rapidly. We also notice that some patients develop osteonecrosis and osteoporosis. We monitor bone density in all patients that receive high corticosteroids. We try to taper them in selected cases. We administer also base phosphonates particularly in those patients with fractures and we add vitamin D in these patients as well. Corticosteroids can also induce peptic ulcer disease. Thus, in patients receiving high dose steroids, we would also give a proton pump inhibitor that prevents the peptic ulcer disease. We control hypertension induced by corticosteroids. We try to avoid food retention. We [also] give some patients diuretics if they have strong food retention and we monitor infections because these patients are at higher risk for viral, fungal, bacterial infections so we give prophylaxis for herpes simplex virus, for fungal infections ... For other immunosuppressive approaches besides corticosteroids, we monitor in particular the infectious complications also in patients receiving MMF [mycophenolate mofetil], everolimus, imatinib, or rituximab. It is very important to understand that these are immunosuppressive approaches where viral, fungal and bacterial infections need to be monitored and patients should receive prophylaxis.

Transcript edited for clarity.