Chronic GVHD First-Line Therapy
A GVHD expert comments on the frontline therapy available for the condition.
Robert Zeiser, MD: First-line treatment for chronic graft-vs-host disease [GVHD] depends on the severity of the chronic GVHD. For the more severe forms and moderate or severe chronic GVHD, systemic corticosteroids are recommended at a dose of 0.5 to 1 mg/kg of body weight. The challenges of this treatment are that first, some patients—40% to 50%—don’t respond and need a second-line treatment. Steroids induce a lot of adverse effects, including weight gain, edema, diabetes, infections, hypertension, and aseptic bone necrosis. As you can see, there are a lot of adverse effects of this treatment, so it’s desirable to treat as short as possible.
Glucocorticoid-resistant or -refractory acute GVHD is defined as a disease that progresses by day 5 or has no response to treatment by day 7 to the treatment. It has a dose of 2 mg/kg body weight of prednisolone or equivalent other corticosteroids, and the dose is typically divided. For chronic graft-vs-host disease, corticosteroids are given for at least 2 weeks with a dose of 1 mg/kg body weight, and there is progression or no response within this time. At a dosage of 0.5 mg/kg body weight for 4 to 6 weeks, there’s no response or ability to taper the corticosteroids below a dosage of 0.5 mg/kg body weight over 8 weeks.
Transcript edited for clarity.
