Treating Patients With Chronic Graft-Versus-Host Disease in a Second-Line and Later (2L+) Setting
Video Transcript
I'm Shernan Holton. I'm the Chief of Blood and Marrow Transplant at Roswell Park Comprehensive Cancer Center. So, I have a 52-year-old man who underwent peripheral blood stem cell transplantation from an HLA-matched sibling donor for high-risk myelodysplastic syndrome. By nine months post-transplant, he developed multi-organ chronic graft versus host disease. This involved his skin with an erythematous rash that eventually progressed to some sclerosis; oral mucosa, which included painful ulcers and sensitivity in his mouth; ocular involvement, which included dry eyes, pain, and sensitivity; as well as the GI tract, which resulted in diarrhea and abdominal cramping. He was initially treated at this presentation with first-line sirolimus and prednisone. This provided some partial improvement, but sirolimus was ultimately discontinued due to concerns of peripheral edema as well as cytopenias. Subsequently, ibrutinib was initiated for the persistent rash and mucosal disease. This also led to some clinical improvement, but the patient had worsening diarrhea that actually got to be so significant he had to stop the drug. When the disease flared again, he was started with ruxolitinib. This also provided moderate control of his symptoms. Thank you for considering this patient case.
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