Late Onset and Protracted Course of Steroid Refractory Chronic Graft-versus-Host Disease

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Chronic graft-versus-host disease (cGVHD) is a significant complication following allogeneic hematopoietic stem cell transplantation (aHSCT).
• cGVHD affects 30-70% of patients, typically manifesting within 2 years post-transplant, with a median onset of 4-6 months.
• Late-onset cGVHD, occurring beyond the typical timeframe, presents unique clinical challenges.

Purpose of the Study:

• To report a rare case of refractory cutaneous cGVHD presenting significantly later than the usual onset period.
• To underscore the importance of considering cGVHD even in patients with a long post-transplant interval.
• To contribute to the understanding of the extended natural history of cGVHD.

Main Methods:

• Case report presentation.
• Review of patient's clinical history and transplant details.
• Description of diagnostic criteria and management of refractory cutaneous cGVHD.

Main Results:

• A 55-year-old patient developed refractory cutaneous cGVHD more than 5.5 years after aHSCT.
• This presentation is substantially later than the typical median onset of 4-6 months and the common 2-year window.
• The case illustrates a prolonged and atypical disease course.

Conclusions:

• Chronic graft-versus-host disease can manifest with refractory cutaneous involvement years after allogeneic hematopoietic stem cell transplantation.
• This case expands the known timeline for cGVHD onset, emphasizing the need for continued vigilance.
• Further research into the mechanisms and management of late-onset cGVHD is warranted.