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Current Dermatology Reports

Erschienen in:

11.11.2019 | Hospital-Based Dermatology (L Guggina and A Zhou, Section Editors)

Inpatient Management of Mucocutaneous GVHD

verfasst von: Toral S. Vaidya, Christian Menzer, Doris M. Ponce, Alina Markova

Erschienen in: Current Dermatology Reports | Ausgabe 4/2019

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Abstract

Purpose of Review

Graft-versus-host disease (GVHD) is an immune mediated disorder affecting 30–70% of patients after allogeneic hematopoietic stem cell transplantation (alloHSCT), and is a major cause of morbidity and non-relapse mortality (NRM) as reported by Jagasia, et al. (Blood 119:296-307, •2012). Dermatologists play a critical role in acute and chronic GVHD, as skin involvement is common and often the earliest involved site of disease as reported by MacMillan, et al. (Biol Blood Marrow Transplant 21: 761-7, 2015).

Recent Findings

GVHD shares clinical and histopathological features with a variety of other skin diseases, requiring thorough consideration of differential diagnoses in hematopoietic stem cell transplantation (HSCT) recipients with lesions suggestive of cutaneous GVHD. Treatment considerations for GVHD are influenced by factors such as disease classification, overall grading, organ involvement, associated symptoms, and immunological anti-tumor effect. Several treatments are available and may be indicated as monotherapy or adjuvant therapy to allow faster withdrawal or tapering of immunosuppression. While corticosteroids are often first-line therapy, oral ruxolitinib has been recently approved for treatment of steroid-refractory acute GVHD (aGVHD), and oral ibrutinib has been approved for steroid-refractory chronic GVHD (cGVHD).

Summary

This article provides current clinical, diagnostic, and therapeutic considerations relevant to the hospitalist for both acute and chronic mucocutaneous GVHD. Optimal inpatient management of these diseases requires an interdisciplinary team.

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Titel: Inpatient Management of Mucocutaneous GVHD
verfasst von: Toral S. Vaidya
Christian Menzer
Doris M. Ponce
Alina Markova
Publikationsdatum: 11.11.2019
Verlag: Springer US
Erschienen in: Current Dermatology Reports / Ausgabe 4/2019
Elektronische ISSN: 2162-4933
DOI: https://doi.org/10.1007/s13671-019-00280-3

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