Summary:Learn how chronic graft-versus-host disease affects the skin after transplant, and therapies to treat it.
Chronic graft-versus-host disease occurs in more than 50% of patients transplanted with cells from a donor. The skin is affected most frequently by GVHD. This presentation describes different types of GVHD of the skin. It also discusses the most common symptoms and promising treatments for this problem.

Presenter: Badri Modi MD, Assistant Clinical Professor of Dermatology, City of Hope. meet Dr. Modi:https://www.cityofhope.org/people/modi-badri

To read the transcript, go to: https://www.bmtinfonet.org/video/chronic-graft-versus-host-disease-skin-and-connective-tissues-1

Highlights:

- There are four distinct layers of skin and GVHD. Depending which layer of skin is affected by GHVD, symptoms may be mild and easily treated, or more severe and long-lasting.
- Severe cases of GVHD can affect the deepest layer of the skin, the fascia, causing scarring or thickening that restricts movement and, in some cases, breathing.
- Skin cancers occur at higher rates for transplant patients (and especially those with chronic GVHD), so sun protection, self-monitoring and annual screenings are strongly encouraged.

Presented at the 2021Celebrating a Second Chance at Life Virtual Symposium, April 17-23, 2021
Presentation is 42 minutes plus 16 minutes of Q & A

Key Points:

(04:40) There are several risk factors for chronic GVHD: prior acute GVHD, peripheral blood stem cell donors, older age of recipient, and poorly matched donors.

(05:48) GVHD of the skin can seriously affect quality of life for those with moderate to severe disease although successful treatment can improve the patient experience.

(10:18) The most common symptoms of GVHD include rash, itching, changes in skin color, sores, and ulcerations.

(15:05) When GVHD affects the deepest layer of skin (fascia), it may cause thickening of the skin or tautness, which can affect range of motion and in some cases, affect the ability to breathe.

(17:12) Some symptoms of skin GVHD, such as sclerosis, can be caused by non-transplant related factors as well, so careful diagnosis is required to establish and effectively treat the underlying cause of the problem.

(21:39) GVHD can cause hanges in skin pigment r and can be difficult to treat or reverse.

(26:54) Nail changes are common in chronic GVHD and are also hard to treat or reverse.

(31:03) Topical steroids and extracorporeal photopheresis can be an effective treatment for GVHD that affects the top surface of the skin. When GVHD affect deeper layers of skin, systemic steroids may be required.

(41:32) Early detection and appropriate treatment can improve quality of life for those with skin GVHD.

Note: In this presentation the speaker sometimes uses the terms “BMT” or” bone marrow transplant”. For purposes of this presentation, both of those terms also apply to patients who have been through a stem cell transplant
Meet the speaker: https://www.cityofhope.org/people/modi-badri


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