An Overview to cGvHD

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EP: 1.An Overview to cGvHD

Understanding Chronic Graft-Versus-Host Disease (GVHD)

Chronic graft-versus-host disease (GVHD) affects approximately 30-50% of patients following allogeneic transplantation, with higher rates (60-70%) seen in matched unrelated donors using peripheral blood stem cell grafts. This transplant complication might be reduced through post-transplant cyclophosphamide based on BMTCTN 17.03 study results. The condition primarily affects eight cardinal organs, with skin involvement being most common, presenting as rashes, scleroderma, or lichenoid plaques.

Joint and facial involvement occurs in approximately 40% of chronic GVHD patients, typically alongside sclerodermatous changes, causing decreased range of movement. Mouth and eye involvement each affect 40-50% of patients, with symptoms including dry mouth, lichenoid plaques, erythema, ulcerations, and chronic dry eyes requiring ophthalmologist monitoring. Gastrointestinal, genital, and lung involvement (bronchiolitis obliterans) are also common, with the latter being particularly difficult to treat and requiring regular pulmonary function testing for early detection.

Chronic GVHD is graded as mild, moderate, or severe based on organ involvement scoring. Mild GVHD (score of 1 in one or two organs) typically responds to topical treatments, while moderate to severe GVHD (score of 2 in any organ or score of 3 in one organ) requires systemic therapy. The standard first-line treatment is corticosteroids (prednisone at 1mg/kg/day) with or without calcineurin inhibitors, with approximately 50% of patients responding and requiring a slow 6-9 month taper to prevent symptom recurrence. The remaining 50% are either steroid-dependent or steroid-refractory and require alternative treatments.