Reflections on the Case and Risk Management for Chronic GVHD

Case: A 42-Year-Old Woman With Moderate Steroid-Refractory Chronic Graft-Versus-Host Disease

Initial Presentation

• A 42-year-old woman previously underwent myeloablative conditioning and an allogeneic PBSC transplant for acute myeloid leukemia
• Received tacrolimus and methotrexate for GVHD prophylaxis
• At 11 months post-transplant, patient developed moderately dry and painful eyes, mild muscle and joint pain, mild erythematous rash on face and arms

First-line Treatment

1. Patient received eye drops, topical steroid cream for rash, and was started on oral prednisone at 0.5 mg/kg/day
2. After 4 weeks of treatment, eye dryness resolved, but the patient’s skin rash and muscle/joint pain worsened; steroid dose was increased to 1 mg/kg/day
3. Skin rash and muscle/joint pain continued despite increased steroid dose

Second-line Treatment

Patient is now receiving ruxolitinib 10 mg orally twice daily, alongside 1 mg/kg/day steroids