Considerations for Steroid Therapy in cGVHD: Optimizing Patient Care

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

Now Viewing

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

Clinical Case Continued (Part 2)

In the clinical case, prednisone at 0.5 mg/kg/day was initiated with a 6-week taper. The patient initially improved but experienced progression during tapering. Steroids were increased again, but another taper was unsuccessful, leading to diagnosis of steroid-refractory cGVHD.

For management of steroid-induced complications, the panel emphasized:

• Internal medicine principles for managing diabetes, hypertension
• Involvement of specialists (endocrinology, cardiology, primary care)
• Attention to bone health to prevent osteoporosis

For infection prophylaxis in cGVHD patients on immunosuppression:

• All provide varicella zoster virus prophylaxis, especially at ≥0.5 mg/kg steroids
• Fungal prophylaxis for prolonged steroid use
• Pneumocystis jirovecii pneumonia (PJP) prophylaxis (Bactrim can cover both PJP and encapsulated organisms)
• Some centers also provide prophylaxis against encapsulated organisms
• Awareness of functional asplenia and T/B cell dysfunction in these patients

For vaccinations:

• Nonstandardized approaches across centers
• Generally continue flu and COVID-19 vaccines
• Some hold nonessential vaccines until prednisone <20 mg/day
• Avoid live vaccines until off immunosuppression
• Shingrix typically delayed until 8 months off immunosuppression