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What Causes Chronic GVHD After Hematopoietic Stem Cell Transplantation?
Question: Myself XXXX age 32 years underwent stem cell transplant from unrelated donor from Germany for relapsed Acute Myloid Leukemia in October 2008.
Almost 6 years post transplant developed sclerodermatous gvhd at present situation is worst with tightening of skin,shiny skin , skin peeling,itching,fibrosis lesions developed over some parts of body.
I am on following Medications:
Tab. Medrol 8 mg Alternate day
Tab.Telma 80 mg OD
Tab.Dytor 5 mg OD
Tab.Ivabradine 5 mg OD
Tab.Metocard 50 mg OD
Every Alternate day in a week going for Photo therapy sessions.
No improvement is there
Kindly suggest about further course of action any changes in line of treatment is this treatment going is OK will this issue be resolved in future.
Waiting for your reply!!!!!!!
Almost 6 years post transplant developed sclerodermatous gvhd at present situation is worst with tightening of skin,shiny skin , skin peeling,itching,fibrosis lesions developed over some parts of body.
I am on following Medications:
Tab. Medrol 8 mg Alternate day
Tab.Telma 80 mg OD
Tab.Dytor 5 mg OD
Tab.Ivabradine 5 mg OD
Tab.Metocard 50 mg OD
Every Alternate day in a week going for Photo therapy sessions.
No improvement is there
Kindly suggest about further course of action any changes in line of treatment is this treatment going is OK will this issue be resolved in future.
Waiting for your reply!!!!!!!
Brief Answer:
Hydroxychloroquin can be added as well as a topical steroid cream
Detailed Answer:
hello. thank you for writing to us
I am dr.kakkar(dermatologist). i have gone through your query an i have noted your concern.
cGVHD is a known side effect of hematopoietic stem cell transplant (HSCT) specially in those who have an unrelated donor. It is characterised by immune mediated sclerosis of skin. Corticosteroids are first line treatment options for cGVHD because they are immunosuppressive. You are already on corticosteroids (medrol and phototherapy). Apart from increasing the fose of corticosteroids if your cardiac status allows other options that can be tried in addition to corticosteroids are phototherapy are oral hydroxychloroquin and imatinib mesylate (IL 1 Receptor antagonist, anakinra). However these measures are more effective in arresting sclerosis rather than reversing but they are worth a try, specially hydroxychloroquin. Response is slow and it may take 4-6 weeks for noticeable benefit. In addition you may also a topical potent corticosteroid cream e.g tenovate cream, twice daily, are the areas which are most affected. This will be of added benefit. Having said that none of the above measures is of unequivocal or proven benefit in cGVHD though, used alone or in combination, they are somewhat effective in reducing morbidity.
Regards
Hydroxychloroquin can be added as well as a topical steroid cream
Detailed Answer:
hello. thank you for writing to us
I am dr.kakkar(dermatologist). i have gone through your query an i have noted your concern.
cGVHD is a known side effect of hematopoietic stem cell transplant (HSCT) specially in those who have an unrelated donor. It is characterised by immune mediated sclerosis of skin. Corticosteroids are first line treatment options for cGVHD because they are immunosuppressive. You are already on corticosteroids (medrol and phototherapy). Apart from increasing the fose of corticosteroids if your cardiac status allows other options that can be tried in addition to corticosteroids are phototherapy are oral hydroxychloroquin and imatinib mesylate (IL 1 Receptor antagonist, anakinra). However these measures are more effective in arresting sclerosis rather than reversing but they are worth a try, specially hydroxychloroquin. Response is slow and it may take 4-6 weeks for noticeable benefit. In addition you may also a topical potent corticosteroid cream e.g tenovate cream, twice daily, are the areas which are most affected. This will be of added benefit. Having said that none of the above measures is of unequivocal or proven benefit in cGVHD though, used alone or in combination, they are somewhat effective in reducing morbidity.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Kakkar S. ,
Greetings for the day!!!!!!
tried HCQS 200 mg OD later stopped by eye dr & with Imatinib had severe side effect so it was stooped.
Now with prolong use of Medrol hypertension issue is there with BP ranging from 160 by 100 & frequent palpitation tachycardia.
I am enclosing as attachment my treatment summary & images of my current skin conditions.
Greetings for the day!!!!!!
tried HCQS 200 mg OD later stopped by eye dr & with Imatinib had severe side effect so it was stooped.
Now with prolong use of Medrol hypertension issue is there with BP ranging from 160 by 100 & frequent palpitation tachycardia.
I am enclosing as attachment my treatment summary & images of my current skin conditions.
Brief Answer:
Use a potent topical steroid applied over a moisturiser
Detailed Answer:
Hi. Thank you. I have reviewed the images and report.
I am of the opinion that in addition to phototherapy you would benefit from use of a potent topical steroid cream e.g Halovate-S ointment applied after a moisturiser, twice daily, over the areas most affected. Hopefully this will allow taper from oral steroids.
In addition you may take a tablet of levocetrizine 10 mg (Teczine 10) for symptomatic relief from itching.
Regards
Use a potent topical steroid applied over a moisturiser
Detailed Answer:
Hi. Thank you. I have reviewed the images and report.
I am of the opinion that in addition to phototherapy you would benefit from use of a potent topical steroid cream e.g Halovate-S ointment applied after a moisturiser, twice daily, over the areas most affected. Hopefully this will allow taper from oral steroids.
In addition you may take a tablet of levocetrizine 10 mg (Teczine 10) for symptomatic relief from itching.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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