cGVHD Case Introduction and Initial Management

Segment 4 introduces a detailed patient case. The patient is a 48-year-old individual with acute myeloid leukemia who underwent a myeloablative matched unrelated donor transplant with tacrolimus and methotrexate prophylaxis. Early post-transplant acute skin GVHD resolved with steroids, and the patient achieved complete remission at three months.

Ten months post-transplant, the patient presents with multi-organ cGVHD, including extensive skin hyperpigmentation, superficial sclerosis involving 22% body surface area, limited shoulder range of motion, and gastrointestinal symptoms. Pulmonary function tests are initially normal. Based on these findings, the patient is diagnosed with moderate, multi-organ cGVHD and started on first-line prednisone at 1 mg/kg/day.

Dr. DeFilipp uses this case to illustrate typical real-world presentations, particularly the presence of sclerotic features that signal more advanced disease biology. The segment sets up key management questions regarding steroid responsiveness, durability of benefit, and timing of escalation, which are explored in subsequent segments.