Inpatient Management of Mucocutaneous GVHD

Overview

Journal Curr Dermatol Rep

Specialty Dermatology

Date 2020 Dec 14

PMID 33312761

Citations 3

Authors

Toral Vaidya

Christian Menzer

Doris M Ponce

Alina Markova

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Graft-versus-host disease (GVHD) is an immune mediated disorder affecting 30 - 70% of patients after allogeneic hematopoietic stem cell transplantation (alloHSCT), and is a major cause of morbidity and non-relapse mortality (NRM) [1]. Dermatologists play a critical role in acute and chronic GVHD, as skin involvement is common and often the earliest involved site of disease [2].

Recent Findings: GVHD shares clinical and histopathological features with a variety of other skin diseases, requiring thorough consideration of differential diagnoses in hematopoietic stem cell transplantation (HSCT) recipients with lesions suggestive of cutaneous GVHD. Treatment considerations for GVHD are influenced by factors such as disease classification, overall grading, organ involvement, associated symptoms, and immunological anti-tumor effect. Several treatments are available and may be indicated as monotherapy or adjuvant therapy to allow faster withdrawal or tapering of immunosuppression. While corticosteroids are often first line therapy, oral ruxolitinib has been recently approved for treatment of steroid-refractory aGHVD, and oral ibrutinib has been approved for steroid-refractory cGHVD.

Summary: This article provides current clinical, diagnostic, and therapeutic considerations relevant to the hospitalist for both acute and chronic mucocutaneous GVHD. Optimal inpatient management of these diseases requires an interdisciplinary team.

Citing Articles

Dermatologic complications in transplantation and cellular therapy for acute leukemia.

Babakoohi S, Gu S, Ehsan H, Markova A Best Pract Res Clin Haematol. 2023; 36(2):101464.

PMID: 37353285 PMC: 10291442. DOI: 10.1016/j.beha.2023.101464.

Chronic graft-versus-host disease. Part II: Disease activity grading and therapeutic management.

Baumrin E, Loren A, Falk S, Mays J, Cowen E J Am Acad Dermatol. 2022; 90(1):19-36.

PMID: 36572064 PMC: 10287839. DOI: 10.1016/j.jaad.2022.12.023.

Clinical Trials of the BTK Inhibitors Ibrutinib and Acalabrutinib in Human Diseases Beyond B Cell Malignancies.

Zhu S, Jung J, Victor E, Arceo J, Gokhale S, Xie P Front Oncol. 2021; 11:737943.

PMID: 34778053 PMC: 8585514. DOI: 10.3389/fonc.2021.737943.

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