Case Commentary and Considerations for Treatment and Management

Case: A 58-Year-Old Man With Moderate Steroid-Refractory Chronic Graft-Versus-Host Disease

Initial Presentation

• A 58-year-old man previously underwent myeloablative conditioning and an allogeneic PBSC transplant for acute lymphocytic leukemia
• Received tacrolimus and methotrexate for GVHD prophylaxis
• At 10 months post-transplant, patient developed moderate muscle and joint pain with decreased range of motion, mild erythematous rash on cheeks

First-line Treatment

• Patient received topical steroid cream for rash, and was started on oral prednisone at 1 mg/kg/day
• After 4 weeks of treatment, the patient’s rash resolved but muscle/joint pain continued

Second-line Treatment

• Patient is now receiving ruxolitinib 10 mg orally twice daily, alongside 1 mg/kg/day steroids