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EBMT 2018 | Diagnosing GvHD timeously

From the European Society for Blood and Marrow Transplantation (EBMT) 2018 Annual Meeting, held in Lisbon, Portugal, Steven Pavletic, MD, MS, from the National Cancer Institute, Bethesda, MD, discusses the diagnostic approach for chronic graft-versus-host disease (GvHD).

Transcript (edited for clarity)

The first approach is actually to say, this is chronic graft versus host disease then we do stay and scoring of the disease we look at the eight key organs that are usually affected with chronic graft versus host disease is eyes, mouth, skin, liver, gastrointestinal tract, genital tract, and some others, and based on the severity of symptoms and functional disability, we give scores zero to three, the three is most severe and most disabling, and then once each score is obtained for each organ...

The first approach is actually to say, this is chronic graft versus host disease then we do stay and scoring of the disease we look at the eight key organs that are usually affected with chronic graft versus host disease is eyes, mouth, skin, liver, gastrointestinal tract, genital tract, and some others, and based on the severity of symptoms and functional disability, we give scores zero to three, the three is most severe and most disabling, and then once each score is obtained for each organ.
We use the 2014 NIH scoring criteria and based on those scores that it takes three minutes in the clinic to check these boxes, you devise something with a global score that could be mild, moderate, and severe. The purpose of scoring is like in cancer, you want to know about the extent, you want to know about the severity, you want to know about the prognosis, you want this to help you with your therapy planning, and you want this to help you with enrolment, and defining criteria for clinical trials.
Once diagnosis scoring is completed, then we have to decide how and if you’re going to treat the patients’ mild scores of chronic graft versus host disease required, or just some topical treatments, that means some corticosteroid creams or eyedrops or physical medicine, rehabilitation, estrogen creams or something when it’s more than mild.
So any moderate or severe global score of chronic graft versus house disease requires systemic therapy. The frontline systemic therapy for chronic graft versus host disease is corticosteroids, usually starting dose is one milligram per kilo of prednisone per day, and then after one or two weeks, you gradually taper this to approximately half of the dose on the every other day and you stay there as long as patient is having some benefits, it usually takes several months and we say for corticosteroids they’re our best friends, they are very effective, they’re our worst enemies they have a long list of undesirable side effects like sterility, diabetes, insomnia, steroid myopathy, patient don’t like it, doctors don’t like it, but this is a current standard.
There’s some new treatments coming, we’re trying to get away from steroids, but this is still years down the road and we are working on this.

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