1 / 22

I cured my own GVHD

Outline. CaseOverview of GVHClinicalPathophysiologyOverview of current aGVH managementPotential of autologous stem cell infusion as treatment. Case. A 29 year old male was diagnosed with acute promyelocytic leukemia in March 2005. He was successfully induced and consolidated with standard ther

brendy
Download Presentation

I cured my own GVHD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. I cured my own GVHD Jeevan Sekhar Hem/Onc Grand Rounds March 20, 2009

    2. Outline Case Overview of GVH Clinical Pathophysiology Overview of current aGVH management Potential of autologous stem cell infusion as treatment

    3. Case A 29 year old male was diagnosed with acute promyelocytic leukemia in March 2005. He was successfully induced and consolidated with standard therapy including ATRA. Autologous stem cells collected in 8/06 3/07 he relapsed and dz persisted despite 2 cycles of arsenic. Gemtuzumab (Mylotarg) worked. Concern that dz was too refractory so got allo transplant w/ bu/cy conditioning

    4. Case cont’d D+ 30, he developed grade IV GI acute GVH Treated w/ methylpred, pentostatin, tacrolimus, budesonide, beclomethasone. Nothing worked. Then idea to ablate the graft. Reconditioned with fludarabine, cytarabine, and 200 cGy TBI and reinfused with autologous stem cells in 12/07. In 4-6 weeks, GVH improved In 11/07, chimerism studies revealed full donor engraftment. In 12/07 chimerism studies after autologous SCT showed only recipient cells. At the end of 12/07, biopsy revealed grade II GVH.

    5. Acute GVH Mainstay of treatment is high dose steroids However, only about 50% respond, the rest are steroid refractory. Mortality with steroid refractory GVH is about 50% Thus, intense area to be addressed to improve post-transplant survival

    6. Overview of acute GVH Risk up to 50-60% in matched related donors despite immunosuppresant prophylaxis Risk factors: Increased age Degree of mismatch Doses of prophylactic immunosuppresants Source of cells Conditioning regimen – more intense, the greater the risk

    7. Clinical Manifestations of Acute GVH Skin First manifestation Most common Si/Sx Maculopapular rash usually at the time of engraftment. Involves epidermal and dermal layers T cell infiltrate Severe disease includes bullae formation and desquamation

    8. Clinical Manifestations cont’d -Liver- Second most common Unlikely to have liver manifestation without skin. Manifested as abnormal liver tests Definitive diagnosis only by Bx

    9. Clinical Manifestations Cont’d - GI Tract- GI Tract Most commonly lower GI tract Non-specific symptoms: Diarrhea Abd Pain Diagnosis by rectal bx showing crypt necrosis and epithelial denudation similar to skin GVH

    10. Pictures

More Related