Limitations of Steroids and Early Escalation in cGVHD Treatment

Segment 5 examines the patient’s response to first-line corticosteroids and uses it to discuss broader limitations of steroid therapy in cGVHD. Although the patient experiences an initial improvement in skin involvement, attempts at tapering result in disease flare and progression, a pattern Dr. DeFilipp notes is highly reflective of real-world experience.

He explains that although steroids may reduce inflammatory manifestations early, they rarely produce deep or durable responses, particularly in patients with sclerotic disease. Prolonged exposure is also associated with significant toxicity, reinforcing the need for timely transition to second-line therapy. Dr. DeFilipp questions whether waiting a full month before escalating treatment is optimal and suggests that steroid failure may be apparent as early as the first unsuccessful taper.

The segment emphasizes a proactive treatment philosophy: maintaining steroids while introducing a more effective agent early to prevent further disease progression. This approach minimizes cumulative steroid exposure and addresses the underlying disease more effectively.