A 49-Year-Old Man With Steroid-Refractory Chronic Graft Versus Host Disease
Corey S. Cutler, MD, MPH, FRCPC, provides insight on the case of a 49-year-old man with chronic GVHD and reviews current and emerging treatment options for disease management.
Case: A 49-Year-Old Man With Steroid-Refractory Chronic Graft Versus Host Disease
Initial presentation
- A 49-year-old man complains of “color and texture” changes to his skin, nails and the inside of his mouth; he also complains of shoulder and elbow joint discomfort limiting his normal daily activity
- PMH: he underwent matched related allogenic transplant from his brother for treatment of AML
- PE: depigmentation and lichen planus-like features noted on his chin, nose, cheeks and forearms bilaterally, and in the oral mucosa (~40% BSA); longitudinal ridging of the fingernails; joint stiffness and decreased range of motion
Clinical workup
- Labs: plt 70 x 109/L, total bilirubin 7.6 mg/dl, AST 150 U/L, ALT 165 U/L, ALP 430 U/L
- Negative for HBV, HBV, CMV, EBV, HHV-6
- NIH Global Severity of cGvHD moderate cGvHD; P-ROM score 4
- ECOG 1
Treatment
- Tacrolimus + dexamethasone oral rinse
- No treatment response after 4 weeks
- He was started on ruxolitinib 5 mg PO BID which was tolerated well; increased to 10 mg PO BID on day 6
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