Long-Term Follow-Up

Graft-vs.-Host-Disease

   

Q. What is the risk for developing chronic graft-vs.-host disease (GVHD) after transplant?

About 60 percent of patients who receive an allogeneic transplant and are alive at day 100 will develop chronic GVHD.


Q. What would indicate a need for systemic treatment of chronic GVHD?

Systemic immunosuppressive treatment with a medication like prednisone is not usually necessary for patients who have mild chronic GVHD. For example, someone with a platelet count greater than 100,000 and mild symptoms in just one site, such as the mouth, would probably not require systemic treatment. Someone with chronic GVHD involving multiple sites such as liver and skin or eyes and genital tract, or someone with chronic GVHD and a platelet count less than 100,000 would require systemic therapy. If symptoms are severe, systemic immunosuppressive treatment may be needed even when only a single site is involved.

Your doctor, can determine if you need systemic treatment. The LTFU is available to help your doctor in making this decision.


Q. What is standard treatment for initial diagnosis of chronic GVHD requiring systemic treatment?

Treatment with daily prednisone should begin as soon as possible after diagnosis of chronic GVHD. In general, treatment with cyclosporine or tacrolimus should also be continued if you were taking one of these medications before the onset of chronic GVHD. Treatment should continue at the initial dose of prednisone until there is improvement in the chronic GVHD symptoms. At that point, the doctor will recommend a schedule to slowly decrease or "taper" the dose over time. If there is no improvement after two months of treatment with prednisone then additional immunosuppressive medications may be needed. Additional treatment should begin sooner if chronic GVHD symptoms progress.

 

Q. What are the side effects associated with the long-term use of prednisone?

Long-term treatment with high-dose prednisone is associated with complications. These complications may include avascular necrosis (a degeneration of the bones, often in the hips), glucose intolerance requiring the use of insulin, infections, hypertension (high blood pressure), weight gain, changes in body or face shape ("moon face"), cataracts, osteoporosis (decreased bone density), mood swings, problems with sleep, and slowing of growth in children.

   

Q. Is any new therapy for treatment of chronic GVHD available?

Investigators at Fred Hutchinson have recently opened a new protocol for treatment of newly diagnosed chronic GVHD. This is a multi-center double-blind study involving the addition of mycophenolate mofetil (MMF) or placebo to the standard treatment of prednisone plus cyclosporine or tacrolimus. The objectives of the study are to test the effectiveness of adding MMF and to assess whether the addition of MMF improves quality of life, due to a faster prednisone taper.

   

Q. How long can I expect to be treated for chronic GVHD?

Treatment of chronic GVHD usually lasts about 2.5 years. Some patients require treatment for shorter periods, while other require treatment for more than 5-10 years.


Bibliography

Paul J. Martin, Paul A. Carpenter, Jean E. Sanders, Mary E.D. Flowers. Diagnosis and Clinical Management of Chronic Graft-versus-host Disease. International Journal of Hematology; 2004

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