Clinical Perspectives for Systemic Therapy in Steroid-Refractory cGVHD

Steroid Management and Prophylaxis

This segment focuses on steroid management and prophylaxis in chronic GVHD patients. The panel discusses steroid tapering approaches (typically 10-mg reductions every 4 weeks, slowing at 20 mg daily) and addressing steroid complications. There's consensus on the importance of infection prophylaxis for chronic GVHD patients on immunosuppression, including:

• Prophylaxis against Pneumocystis jirovecii pneumonia with Bactrim (double-strength daily, if tolerated)
• Coverage for encapsulated organisms
• Antiviral prophylaxis, particularly for varicella zoster virus
• Antifungal/mold coverage for patients on high-dose steroids

The panel notes differences in vaccination approaches between centers, with most agreeing on providing flu and COVID-19 vaccinations regardless of immunosuppression status, while delaying Shingrix until patients are off immunosuppression for extended periods.