An Overview to cGVHD: Disease Pathophysiology and Manifestations

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EP: 1.An Overview to cGVHD: Disease Pathophysiology and Manifestations

EP: 2.Clinical Perspectives: Risk Factors and Patient Characteristics Associated with cGVHD

EP: 3.The Multidisciplinary Approach to cGVHD Diagnosis

EP: 4.Diagnosis of cGVHD: Challenges & Considerations

EP: 5.A 50-Year-Old-Woman With cGVHD

EP: 6.Steroid Therapy for cGVHD

EP: 7.Considerations for Steroid Therapy in cGVHD: Optimizing Patient Care

EP: 8.Clinical Perspectives for Systemic Therapy in Steroid-Refractory cGVHD

EP: 9.FDA Approvals of Systemic Therapy for Steroid-Refractory cGVHD

EP: 10.Frontline Ruxolitinib Therapy for Steroid-Refractory cGVHD

Overview and Pathophysiology of cGVHD

The panel featured Dr Catherine Lee (Fred Hutch Cancer Center), Dr Michael Bishop (University of Chicago), and Dr Paul Shaughnessy (Sarah Cannon Transplant cellular therapy program). Dr Lee opened with the pathophysiology of cGVHD, describing it as resulting from three biologic phases:

1. Early inflammation from pre-transplant conditioning that causes tissue damage and activates host antigen-presenting cells (APCs)
2. Activated APCs secrete pro-inflammatory cytokines and increase MHC and co-stimulatory molecules, initiating alloreactive T-cell responses
3. In cGVHD specifically, loss of peripheral tolerance occurs due to thymic injury and emergence of alloreactive B and T cells, leading to chronic inflammation

The NIH consensus criteria define diagnostic features and severity scoring in 8 classical organ systems (skin, mouth, eyes, lung, musculoskeletal, GI tract, genitourinary tract, liver). However, there are also "suspected" or "atypical" cGVHD manifestations outside these classical systems, including hematopoietic system, endothelium, central/peripheral nervous systems, kidneys, and serous membranes.