Reflections on the Case and Risk Management for Chronic GVHD
Yi-Bin Chen, MD, reflects on the patient case and outlines strategies for educating and managing patients at risk of developing 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
- Patient received eye drops, topical steroid cream for rash, and was started on oral prednisone at 0.5 mg/kg/day
- 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
- 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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