Understanding Symptom Burden, Disease Severity in Graft vs Host Disease

Meilin Diaz-Paez, MSN, APRN, FNP-BC, AOCNP, BMTCN, advanced practice registered nurse, Division of Transplantation & Cellular Therapy, University of Miami Sylvester Comprehensive Cancer Center, reviews the symptom burden associated with chronic graft vs host disease, as well as how clinical considerations change as the disease progresses.

This interview is part of the series, "Current Treatments and Unmet Need in Chronic Graft vs Host Disease."

Read the full transcript:

My name is Meilin Diaz-Paez, and I am a family certified nurse practitioner. I currently work at the University of Miami Sylvester Comprehensive Cancer Center with the Division of Transplantation & Cellular Therapy. I have been a nurse practitioner with transplant for about seven years and spent an additional seven years as a registered nurse at the bedside.

What is graft vs host disease, and what causes it?

Graft vs host disease (GVHD) is an immunological reaction that occurs when the immune system from the graft, which is the recipient's stem cells, recognize the host tissue, which is the patient's organ systems, as foreign and mount an immune attack against the host tissue.

What is the symptom burden associated with chronic GVHD compared to acute GVHD?

The symptom burden can be very high in chronic GVHD. There can be significant impairment in organ function. There can be fibrotic manifestations, such as fasciitis, cutaneous sclerosis, and bronchiolitis obliterans syndrome, which are particularly difficult to manage and often require prolonged treatment.

Clinical manifestations of chronic GVHD vary in severity and can significantly impact the patient's quality of life after transplant. The Lee Symptom Scale, also known as LSS, which is used to measure chronic GVHD, has shown that patients, especially those with moderate to severe disease, have substantial symptom burden.

The duration of the disease’s impact on quality of life is much longer in patients with chronic GVHD, which is often measured in years rather than weeks or months, as opposed to acute GVHD.

How does disease progression impact clinical considerations?

Despite first-line therapy with systemic corticosteroids alone or in combination with sirolimus or a calcineurin inhibitor, more than 70% of patients experience progression and require subsequent lines of therapy, owing to the toxicity and the lack of efficacy associated with many treatments. The degree of progression impacts our selection of subsequent therapies, as well as patient-specific considerations, which include age, performance status, and preference.

For example, some patients may not necessarily want to do extracorporeal photopheresis, so a combined modality treatment is sometimes considered, especially for patients with high-risk features such as bilirubin elevations or thrombocytopenia. However, it's always a balance of risk of toxicity with clinical benefit and titrating dynamically.

This transcript has been edited for clarity.