Steroid Therapy for cGVHD
Panelists discuss how steroid dosing for chronic graft-vs-host disease (cGVHD) typically starts at 0.5-1 mg/kg/day depending on severity, with careful tapering to avoid flares.
Treatment Approaches (Part 1)
For newly diagnosed moderate to severe cGVHD, the panel discussed:
Initial steroid dosing:
- Dr Bishop: 1 mg/kg/day for severe cases, possibly split dosing
- Dr Shaughnessy: 0.5 mg/kg/day for many cases, 1 mg/kg/day for severe lung or liver involvement
- All agree on assessing response for at least 1-2 weeks before tapering
Steroid taper considerations:
- Slow, cautious tapers, especially for cGVHD (unlike acute GVHD)
- Generally 10 mg every 1-2 weeks after stabilization, slowing at 20 mg/day
- Consider adding calcineurin inhibitor if cGVHD developed soon after prophylaxis discontinuation
For high-risk disease with relapse potential:
- Balance between GVHD control and maintaining graft-versus-leukemia effect
- Preference for local therapies when possible
- Recognition that relapse through active cGVHD is rare
Supportive care strategies include:
- Topical therapies for eyes, mouth, and skin
- UV protection and good skin/oral care
- Budesonide for gastrointestinal involvement
- Ursodiol for liver involvement
- FAM (fluticasone, azithromycin, montelukast) therapy for pulmonary involvement
- Physical therapy and rehabilitation for sclerotic and joint involvement
- Pulmonary rehabilitation for bronchiolitis obliterans syndrome
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