Steroid-Refractory Chronic GVHD: Unmet Needs and Future Directions


Closing out his discussion, Yi-Bin Chen, MD, talks about unmet needs, ongoing clinical trials, emerging treatment options for patients with steroid-refractory 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

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