Discussion of Long-Term Effects of GVHD Therapy


Chronic GVHD specialists share commentary on long-term effects of graft versus host disease and therapies for the condition.


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.

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Yi-Bin Chen, MD, an expert on GVHD
Yi-Bin Chen, MD, an expert on GVHD
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