Multidisciplinary Management of Morbidities Associated with Chronic Graft-Versus-Host Disease

Area of Science:

• Hematology
• Immunology
• Oncology

Background:

• Chronic graft-versus-host disease (cGVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (HSCT).
• It is a leading cause of non-relapse mortality and significantly impacts survivors' quality of life.
• Traditional treatment relies on systemic immunosuppression, primarily glucocorticoids, which contribute to iatrogenic morbidity.

Purpose of the Study:

• To review the multifaceted impacts of cGVHD beyond established criteria.
• To highlight iatrogenic complications from long-term immunosuppression.
• To outline a framework for comprehensive multidisciplinary management of cGVHD.

Main Methods:

• Literature review of cGVHD impacts and management strategies.
• Analysis of traditional and emerging treatments for steroid-refractory cGVHD.
• Discussion of systemic effects and quality-of-life implications.

Main Results:

• cGVHD affects nearly all organs and extends beyond NIH Consensus Criteria.
• Emerging oral agents (ibrutinib, ruxolitinib, belumosudil) offer new treatment options for steroid-refractory cGVHD.
• Long-term immunosuppression leads to significant iatrogenic complications.

Conclusions:

• cGVHD poses a substantial burden on HSCT survivors, affecting multiple organ systems and overall health.
• Comprehensive management must address both cGVHD and its treatment-related toxicities.
• A multidisciplinary approach is crucial for optimizing patient outcomes and quality of life.