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EBMT 2018 | Management of chronic GvHD

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

Transcript (edited for clarity)

This session is part of the nursing conference at the EBMT meeting in Lisbon, and the specific objectives for that session is to provide a broad overview of the current approach in clinical management for chronic graft versus host disease.
We know that chronic graft versus host disease is an increasingly complex and frequent complication after allogeneic hematopoietic stem cell transplantation, it involves multiple organs, therefore it’s really dependant heavily on involvement of multiple specialties and multidisciplinary teams...

This session is part of the nursing conference at the EBMT meeting in Lisbon, and the specific objectives for that session is to provide a broad overview of the current approach in clinical management for chronic graft versus host disease.
We know that chronic graft versus host disease is an increasingly complex and frequent complication after allogeneic hematopoietic stem cell transplantation, it involves multiple organs, therefore it’s really dependant heavily on involvement of multiple specialties and multidisciplinary teams.
This is where physicians play a role a key role, but increasingly less so, and they are interdependant on other colleagues specialists in the field and other all kind of levels of practitioners that manage and follow this patient along their long trajectory, from the diagnosis until the disease results. Certainly, chronic disease and the main problem is abundancy of frequently disabling symptoms that we all collectively have to manage. The usual approach in chronic graph versus host disease is the timely diagnosis so we have to maintain awareness that this is possible.
It usually occurs at a time of tapering immunosuppression after allogeneic transplantation, this is between 6 and 12 months after transplantation, the average patient stays on systemic treatments for about 3 years, ultimately in most cases, it resolves our treatments, however, they’re not aiming to cure or they’re not smart enough to cure, but they are frequently, broadly immunosuppressive.
We are becoming smarter these days with some new drugs interfering in this process but really our goal is to suppress the inflammation, prevent damage and disability, provide time to patients, and for the immune system to recover. So everything results and well this is happening, there is a lot of attention to individual organs, specific problems and topical and supportive and ancillary care, we’re including our, what we call in the United States, the mid-level practitioners or nurses they have as well major involvement actually spent more time with the patients than we do.

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