Discussion of Long-Term Effects of GVHD Therapy

EP: 1.Graft versus Host Disease Background

EP: 2.Overview of GVHD Risk Factors

EP: 3.Current GVHD Prophylaxis Strategies

EP: 4.Signs and Symptoms of Acute and Chronic GVHD

EP: 5.Statistics on the Incidence of Chronic GVHD

EP: 6.Identification of Patients at High Risk for GVHD

EP: 7.Assessment of Chronic GVHD Symptoms

EP: 8.The NIH Clinical Scoring of Organ Systems

EP: 9.The Chronic GVHD Treatment Paradigm

EP: 10.Patient Case: A 48-Year-Old Man with Chronic GVHD

EP: 11.Treatment Goals for a Patient With Chronic GVHD

EP: 12.Steroid-Refractory Chronic GVHD Background

EP: 13.Therapy Options for Steroid-Refractory Chronic GVHD

EP: 14.Ibrutinib as Second-Line Therapy for Steroid-Refractory Chronic GVHD

EP: 15.The iNTEGRATE Trial: Ibrutinib With Prednisone as First-Line Therapy for cGVHD

EP: 16.The REACH3 Clinical Trial of Ruxolitinib in Chronic GVHD

EP: 17.Clinical Experience with Ruxolitinib for cGVHD

EP: 18.The ROCKstar Study of Belumosudil in cGVHD

EP: 19.Real-World Experience with Belumosudil

EP: 20.Summary of Axatilimab for cGVHD

EP: 21.Therapy Selection for Patients with Chronic GVHD

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EP: 22.Discussion of Long-Term Effects of GVHD Therapy

EP: 23.Future Directions in Graft Versus Host Disease

Transcript:

Yi-Bin Chen, MD: All right, we are going to move along here and touch on GVHD, treatment- induced damage, right. So, we've sort of talked about how when we give steroids frontline for chronic graft-vs-host disease, it works for some patients, but we pay the price in other ways. So, Colleen, you had mentioned a lot of this in terms of what we watch out for. So, if you could just review the – when we start someone on steroids, what are the sort of the comorbidities that can occur?

Colleen Danielson, NP: We know that steroids obviously are an immunosuppressant. And so, we have to think about patients’ risk of infection. We know that there are long-term consequences for being on steroids, especially at higher doses and for longer periods of time. And so, this sort of list here kind of goes through a lot of these things that we think about. So, immune deficiencies, patients can develop cataracts much earlier on than they would without these treatments; we can see chronic kidney injury, certainly steroid-induced diabetes, especially someone getting started on steroids that already has an underlying diagnosis of diabetes, this can make that much more complicated to manage. We deal with cholesterol issues, and we see that with lots of the different treatments that we're using; steroid myopathy, certainly for patients, especially our older patients, and so sometimes that drives our decision-making around the use of steroids. Adrenal insufficiency is something I think all deal with in our clinic where patients are on steroids a long time at higher doses. And when we try to taper them off, we can see issues with adrenal insufficiency and the symptoms that come with that. Osteoporosis and bone health is a huge factor that we need to think about for patients who are on long-term steroids. So, monitoring their bone densities. Checking vitamin D levels is really important for their long-term bone health. People can deal with neuropathy often are patients who have skin graft-vs-host disease, especially the scleroderma. This type can develop wounds, often nonhealing wounds, or poor wound healing, which can lead to a lot of other issues. And then we have to think about secondary malignancies and PTLD for these patients as well.

Yi-Bin Chen, MD: Yeah, It's complicated. Our patients go through a lot, and they continue to go through a lot. I think the other aspects of chronic graft-vs-host management can fall under comorbidities of therapy. It also [is] just survivorship in general. This figure is from one of our colleagues at Mass General [Massachusetts General Hospital], Areej El-Jawahri, [MD], who heads our survivorship program and has done a lot of research into looking at the long-term quality of life and how to best cater survivorship care for patients going forward, and it's complicated. I think all of our programs have developed ways to try and address this and we're fortunate enough to have more survivors after transplant, but it does give us some more challenges to continue to address their ongoing health care needs.

Transcript is AI-generated and edited for clarity and readability.