The Current Field of Graft Versus Host Disease - Episode 3

GVHD Prophylaxis and Patient Presentation

Selection of prophylaxis regimen is reviewed followed by a discussion of the typical patient presentation of GVHD.

Robert Zeiser, MD: The prophylaxis regimen that I apply to my patients depends on the type of transplants we have. In a patient with a matched related donor, we highly recommend a calcineurin inhibitor combined with antimetabolite. In contrast, in patients with an unmatched nonrelated donor, I’d add ATG [anti-thymocyte globulin] to this conditioning or post-transplant cyclophosphamide. For haploidentical transplantation, I’d always add post-transplant cyclophosphamide to the conditioning because it was clearly shown that this reduces the risk of acute graft-vs-host disease [GVHD].

Chronic graft-vs-host disease is a syndrome of variable clinical features that shares features of autoimmune diseases and other immunological disorders—for example, scleroderma or Sjögren syndrome and primary biliary cirrhosis or bronchiolitis obliterans. The clinical manifestations may be widespread and are possibly involving only certain organs. The primary clinical manifestations are skin involvement: local sclerosis or systemic sclerosis with culture in the position, hardening of the skin, and dry or a mucosa gastrointestinal tract … and sclerosis, which can lead to difficulties for the patients to swallow and elevated liver values in particular bilirubin or transaminase, as well as bronchiolitis obliterans syndrome, which are possibly connected to severe lung GVHD, which clearly reduces the quality of life of patients to the reduced physical fitness.

Transcript edited for clarity.