Case 1: A Patient With Acute Graft-Vs-Host Disease

Corey Cutler, MD, MPH, FRCPC: I’m going to ask my colleague Dr Gergis to review our first case, and this is a case looking at acute graft-vs-host disease [GVHD]. With that, I am going to pass the baton over to Usama.

Usama Gergis, MD, MBA: Thank you, Corey. I appreciate it. The first case is a very classic acute graft-vs-host disease case. Let us start with the case.

A 48-year-old man underwent a matched, unrelated donor bone marrow transplant with GVHD prophylaxis using a very classic regimen: tacrolimus and methotrexate. He went through the transplant as predicted. On day 22, he developed maculopapular rash on his face, upper chest, forearms, shoulders, and back. The BSA body surface area] involvement is approximately 60%. Again, the rule for that is just like the burn unit: 9%/9%, 18%/15%, and 18% each lower extremity.

In addition to the 60% skin involvement, he had 4 episodes a day of watery diarrhea for the past 2 days. Looking at this on day 22, he had rash and diarrhea—very classic, and it affects the majority of our patients. Whether this is graft-vs-host disease or not, that remains to be seen.

It was determined that this was indeed acute graft-vs-host disease. He received prednisone 2 mg/kg per day for 2 weeks. Skin rash was reduced to about 20% to 25%, grade 1, and the diarrhea was gone. Steroids were tapered by about 10% every week. At the end of the 2 weeks, it gets tapered by 10% every week.

Transcript edited for clarity.