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First-line therapy for patients with graft-versus-host disease (GvHD) is treatment with steroids; however, ~50% of patients do not respond to initial treatment.1 To explore how to approach these patients, we spoke to Arnon Nagler, who has provided his opinion on how to treat a particular patient with chronic GvHD who was not responding to prednisone.
The initial characteristics of the patient in question are presented in Figure 1.
Figure 1. Patient characteristics and treatment history
Allo-HSCT, allogeneic hematopoietic stem cell transplant; AML, acute myeloid leukemia; GvHD, graft-versus host disease; MTX, methotrexate; TAC, tacrolimus.
Figure 2. Affected area of the maculopapular rash and oral lesions
Figure 3. Administered therapy and outcome
The patient is young and has developed moderate chronic GvHD with skin mucosal and ophthalmic involvement early post-allo-HSCT (5 months) during tapering of post-transplant immunosuppression. The patient has now failed to respond to 1 mg/kg steroid treatment alongside increased tacrolimus dosing (back to therapeutic levels).
Figure 4. Treatment plan
GI, gastrointestinal; PR, partial response.
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