Sunday May 1, 2022
Presenter: Paul Shaughnessy MD, Sarah Cannon Transplant and Cellular Therapy Program at Methodist Hospital, San Antonio, Texas.
Presentation is 32 minutes long with 23 minutes of Q & A.
Summary: Half of patients who have a stem cell transplant using donor cells (an allogeneic transplant) develop chronic graft-versus-host-disease (GVHD). In up to a third of those patients, GVHD affects the mouth, esophagus, stomach and/or GI tract. GVHD can also affect the liver and/or pancreas. This presentation describes the symptoms and treatment options for GI and liver GVHD.
Highlights:
- Up to a third of patients with chronic GVHD have symptoms in the esophagus, stomach and/or lower GI tract. Symptoms include stomach upset, diarrhea, difficulty swallowing, malabsorption and weight loss.
- GVHD can damage the GI tract and enable bad bacteria to outnumber beneficial bacteria, which can lead to more GVHD and worse outcomes.
- Jakafi® and Rezurock® have recently been approved by the FDA to treat GVHD that does not respond to steroids. Extracorproeal photopheresis (ECP) also helps some patients with GI GVHD.
Key Points:
(08:36): Use of very broad-spectrum antibiotics after transplant can destroy the good bacteria in our bowels and lead to more GVHD.
(11:46): GVHD can damage saliva glands in the mouth, causing dry mouth, mouth sores and an increased risk of cavities or periodontal disease
(13:32): Saliva substitutes can help people who have a dry mouth. If people have pain or cannot eat, Decadron® and tacrolimus rinses can help.
(17:15): GVHD can affect the pancreas, the organ that makes enzymes to helps digest food, causing fat and undigested food in the stool.
(20:39): GVHD can cause strictures in the esophagus which can make swallowing difficult. A procedure called esophageal dilation can help.
(22:21) Jaundice and an increase in bilirubin may be a sign of GVHD in the liver, which can interfere with the digestion of food.
(25:29): Mild or moderate GVHD may be treated with localized or topical agents. Severe GVHD is typically treated with systemic corticosteroids or calcineurin inhibitors.
(26:24): Jakafi®and Rezurock® have recently been approved by the FDA to treat GVHD that does not respond to steroids.
(28:14): Extracorporeal photopheresis, which is FDA-approved for patients with cutaneous T-cell lymphoma, can also help patients with GI or liver GVHD
(30:30): Several specialists including dentists, gastroenterologist, nutritionists and physical therapist may be needed to effectively treat GVHD.