Graft versus Host Disease Practice Updates - Episode 10

Scenario 2: Treatment-Induced Damage in Chronic GVHD

, ,

A brief discussion on the risk of treatment-induced damage when managing patients with chronic graft-versus-host disease.


Nelson Chao, MD: I want to briefly touch on some of this treatment-induced damage. This is part of the big problem we have in some of these patients and dealing with all the damage that we’ve caused. Partly, it’s their chronic graft-vs-host disease [GVHD]. I was wondering if you could go through some of these that you see frequently. Additionally, how, in a multidisciplinary way, can we recognize them quickly and address some of them?

Kerry King Minor, MSN, ANP-BC: Unfortunately, we see a lot of these. I can’t stress enough the importance of continued follow-up. With more patients surviving transplants, this allows us to see the aftermath of transplants and the treatments they’ve seen. I’ve seen it enough to prepare these patients, as part of my initial presentation, that you’ll be with us for a while. We’ll continue to follow up with you. The importance of the survivorship clinic is that we get past the acute concerns of their cancer or their underlying diagnosis and start to shift our view more to managing these items.

Close follow-up is huge. The minute we have any concern of any of these items, we have them plugged in with some of the other specialists. But to be prophylactic or preventive, we need to make sure we’re following up on their bone health. Checking their vitamin D when they come back for a follow-up is important. We tell these patients, “Don’t go in the sun because it can cause GVHD.” But they need to be reminded of the importance of replacing that with a vitamin D supplement. This is to protect their bones. If they’ve been on a long-term steroid and tapered off, have that in the back of your brain and follow up closely with them for adrenal insufficiency. For most of them, if they’ve had issues with steroid-induced diabetes, we just go ahead. Our main practice is to plug them in with an endocrine group that very closely monitors them for the duration.

Another preventive would be cataracts. I’d always recommend, at least by a year, that these patients need to be getting back in for good eye exams. [They also need to] see a dermatologist and make that an annual or every-6-month practice. Getting back in with their PCP [primary care provider] is a learning point for them or a reminder, even if they’ve heard it before, of how important these follow-ups are. Making sure someone is checking their cholesterol, checking their hemoglobin A1C [glycated hemoglobin], and doing their DEXA [dual-energy x-ray absorptiometry] scans is important post-transplant.

Transcript edited for clarity.