EHA 2019 | Clinical practice in chronic GvHD
At the 24th Congress of the European Hematology Association (EHA), Dr Zinaida Peric from the University of Zagreb School of Medicine, Zagreb, HR, outlines the need for a multidisciplinary approach to chronic GvHD (cGVHD) management. This approach is necessary to improve the quality-of-life of patients with GvHD. Dr Peric and colleagues implemented this method of patient care in their center, based on the NIH GvHD Consensus Criteria.
Dr Peric began by stating that currently there is a lack of treatment guidelines, with a wide heterogeneity in the approaches used for cGvHD. The only current clinical standard for GvHD is first-line treatment with systemic steroids. However, if the patient develops progressive onset GvHD, steroid-refractory GvHD or lung GvHD, there are no guidelines.
Some recent changes relate to new drugs such as ibrutinib, and ruxolitinib, though there is no specified treatment plan to accompany these. Dr Peric also highlights that this field needs input from fellow GvHD experts.
Some recommended strategies for cGvHD treatment included developing a supportive care and local therapy plan, and using multidisciplinary approach to treatment, including; collaboration between specialists, education of patients, and input from a GvHD nurse.
Lastly, Dr Peric shared her personal experience of treating patients with refractory cGvHD of the eye. She stated that the use of amniotic membrane transplantation is attractive, since the amniotic membrane has no human leukocyte antigens (HLA) so it can be transplanted without requiring immunosuppression. This also minimizes the risk of rejection. She added this was easily applicable and conferred significant improvement, especially in patients for whom increased immunosuppressive treatment is contraindicated.
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